THE A-Z OF MEDICAL WRITING

Tim Albert learnt the long words studying psychology and the short ones as a Daily Mirror trainee. He then worked for the broadsheets and the BBC and was education correspondent of the New Statesman. Rampant hypochondriasis steered him into medical journalism, and he was executive editor of World Medicine and editor of BMA News Review. Since 1990 he has run his own training company, delivering hundreds of courses on writing to doctors and other health professionals. He is a fellow of the Institute of Personnel and Development, organiser of the BMJ’s annual short course for journal editors, and visiting fellow in medical writing at Southampton University.

THE A-Z OF MEDICAL WRITING
Tim Albert Tim Albert Training, Surrey, UK

BMJ
Books

© BMJ Books 2000 BMJ Books is an imprint of the BMJ Publishing Group All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise, without the prior written permission of the publishers. First published in 2000 by BMJ Books, BMA House, Tavistock Square, London WC1H 9JR www.bmjbooks.com British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN 0-7279-1487-1

Typeset by Saxon Graphics, Derby Printed and bound in Great Britain by J W Arrowsmith Ltd, Bristol

Contents

Foreword How to use this book The A–Z of Medical Writing

vii ix 1

even though I stray into these areas from time to time.Foreword This book has not been written to be read – at least in the usual sense of starting at the beginning. style. encouragement. they have more useful things to do anyway. or journalology. Writing cultures have grown up that are. They are torn between the pressure to communicate with patients on the one hand. ploughing on to the end. and then remembering (at best) one or two points. or the presentation of statistics or the ethics of publication. destructive of effective communication and individual talent. So this is not another reference book laying down rules on grammar. from abbreviations to zzzzz. I have chosen a large number of topics. as trained doctors rather than trained writers. Tim Albert vii . which has come from my experiences over the past 10 years working with doctors and other health professionals to sort out a wide range of writing problems. Acting on the experience of training courses. Although they will have had no formal training on writing since they were 16. and informed advice. they will be expected to publish in high status journals if they are to advance in their careers. What this book sets out to do is to give support. And of course. It is clear that they face several difficulties when it comes to writing. I have written it for a completely different purpose. and meet the expectations of their peers for horrendously prolix prose on the other. which are arranged alphabetically. frankly. so that people who have found writing hard will somehow find it less hard.

amuse. has been my wife Barbara. is a personal choice. You have been asked to write an obituary. The person who has suffered most for my art. These are Gordon Macpherson. including suggestions for new items to be covered in the next edition. Mary Banks and Michèle Clarke. The first is as an oldfashioned companion. and other pieces of advice and comment. and that we shall be able to make regular updates. Don Rowntree. The second is to use it for advice and encouragement when you have a specific writing problem. as always. In such cases.How to use this book I expect this book to be used in two ways. you should turn to the specific entry. Geoff Watts. Tim Albert Dorking tatraining@compuserve. to whom I offer my special thanks. Finally I would like to thank all those who have helped. Geert-Jan van Daal. Pete Moore. and I am sure that many topics could have been dealt with differently. with this book.com ix . A word in bold type shows that there is another section also of use. To that end I hope that readers will send me their comments. and in some cases to details of books that I have on my bookshelf and find useful. in their various ways. which in turn should guide you to other related entries. to be kept by a bedside or on a desk. Margaret Hallendorff. and that some important ones have been left out altogether. stimulate or annoy. This book. so that you can dip into it during an otherwise idle moment and find the odd entry that will interest. or you are suffering from writer’s block. I hope that this book will evolve. as the title makes clear. Harvey Marcovitch. both in the paper version and in electronic form. for instance.

and the principal conclusions: ‘It should emphasize new and important aspects of the study or observation’. basic procedures. main findings. Those who want to avoid abbreviations can usually do so. for instance by spelling out in full one of the component words: ‘the association’. summarizing the information contained in that paper. or (as I once saw in a conference hotel in America) a Branch Marketing Assistant. they slow the reader down. See also tautology. I call these conference abstracts and they have an entry to themselves (see below). and because they are in upper case. only to resurface after an absence of several paragraphs when you have completely forgotten what they stand for. The initials CIA are identified so closely with US spies that it may be difficult to remember that they also stand for common iliac arteries. if you are uncomfortable with it. Opponents say that abbreviations mislead and confuse. One person’s British Medical Association will be another’s British Midland Airways.ABBREVIATIONS A–Z of Medical Writing Abbreviations Modern science writing is written increasingly in a kind of code. In some respects they are a marketing tool. an abstract should state the purposes of the study or investigation. ‘the airline’ or ‘the assistant’. Proponents argue that this is inevitable. political writing). as a means of securing an invitation to present at a conference. The confusion intensifies when the abbreviations disappear for a while. make sure that you spell out the words in full at their first appearance. it reflects the increasing specialization of medicine and saves valuable space for yet more papers. where the first word is redundant (though not ‘totally redundant’!). If you do insist on using abbreviations. and try to use no more than two sets per document (see acronyms. Abstracts There are two types of abstracts. There are those that stand on their own. For this reason. The other type are those that appear at the start of a scientific paper. They also send a strong message to the reader: this is our language. According to the Vancouver Group. you don’t belong. Absolutes Many people use phrases such as ‘absolute perfection’ and ‘completely exhausted’. 1 . littered with phrases such as ‘a breakthrough in PE’ and ‘no laboratory monitoring of APT’.

There are two pitfalls to avoid. such as general support by a department chair. and look at abstracts in your target journal. Acknowledgements According to the Vancouver Group these are the statements accompanying a scientific paper that ‘specify (a) contributions that do not justify authorship. so you must have their written permission. Journals will make it absolutely clear in the Instructions to Authors how they like their abstract to appear. One of the most commonly flouted requirements is length: if they say 300 words they mean 300 words. It is not hard to find examples of submitted (and sometimes published) articles where details in the abstract simply do not appear in the article itself. With the development of electronic databases. 2 . • Ignoring the specifications. which has carefully defined sections to complete. they now have a role as a stand-alone unit of scientific knowledge. which should specify the nature of the support. (c) acknowledgements of financial and material support.THE A Z OF MEDICAL WRITING – enabling potential readers to decide whether they should read the paper in detail. Study the instructions carefully. and (d) relationships that may pose a conflict of interest’. By the time the paper has been written and the co-authors have agreed. A modern trend is the structured abstract. In such instances it is used to acknowledge Copyright material. and it is senseless to ignore these requirements. Naming people in this way assumes that they endorse the contents. Technical help should be acknowledged in a separate paragraph. Don’t just try to cut your article back to fit the space available. but treat this as a separate piece of writing. all kind of subtle changes have been made. Journals will vary in their approach to this (see Instructions to Authors). Acceptance The supreme moment when something you have written is accepted for publication. • Deviating from the original. Treasure it. The word can have a slightly different meaning when it comes to books. Approach writing an abstract in the same way as you would approach any other writing task (see process of writing). This danger is particularly acute when the abstract has been written first. (b) acknowledgements of technical help. any more may be cut and your work could become meaningless.

the hard thing is ensuring that they are carried out. Adverbs The words that modify a verb (or ‘doing’ word). within their contexts (see style guides). make sure it has not already been taken. Adjectives Describing words. ran four miles on the treadmill. 3 . you write it with one initial capital only. and by when. The place of the active in science writing is confused and controversial (see verbs. and attended a bar mitzvah’). voice). write down in clear active language. such as ‘old’. Action lists These are beginning to take over from the more traditional minutes as the preferred way of recording the activities of a committee. so if you want to use one. Say exactly how old (‘41 years and a day’). We overuse them dreadfully: ‘When you catch an adjective. the HOT trial or just plain MONICA. although AIDS seems to be the preferred style in medical journals. ‘busy’. To produce an action list. Both are right. Active The basic way of writing a sentence. ‘quickly’. and are currently the fashionable way to describe (and market) a piece of science – the ARIC study. The number is exploding. in which someone or something does something to someone or something else. They are based on the principle that recording the decisions is fairly straightforward. if you can pronounce an acronym. kill it’. Review at the start of each meeting. these can be overused. by whom. what has to be done. Again. or how we can tell that the person was busy (‘Between lunch and tea she chaired three meetings. Many newspapers and magazines adopt the style that.’ Advertising Written material that promotes the interests of whoever paid for it. Thus: ‘Dr Smith wrote the article’ and ‘The article changed the world’. such as ‘slowly’. This explains why. Thus UN but Unesco. Prefer nouns and verbs: ‘He took four hours to answer the question. said Mark T wain. Distinguish from editorial.ACRONYMS Acronyms These are abbreviations that can be pronounced as a word. most other publications style it Aids.

there are two main ways of finding an agent. are slight. The problem is knowing when their advice is useful – or ill-informed and dangerous. look up the names of some agents. Your chances of being accepted by the first agent. What do you offer that will give enough income for two to share? If you believe that you are about to make huge amounts of money from your writing and want some help in getting the best deal. ‘mouthwatering desserts’. Beware those who base their comments on their own views on ‘good writing’ without finding out how you have defined your audience and what you want your writing to achieve (see false feedback loop). local publications. First published in the first decade of the 20th century. 1999. ‘friendly staff ’. BOOKLIST: agents • Writers’ and artists’ yearbook. do not always do so. They appear more frequently in smaller. plus useful articles on a range of topics from copyright to research and the Internet. Editors should make it clear that these are advertising features but. alas. such as the Society of Authors. This process is unlikely to be scientific. this has nearly 700 pages packed with names. 4 . They will also give you balanced feedback. but are in fact paid for by an advertiser. and identify one or two that sound suitable. addresses and other information. or even any agent. The best answer is to turn it round: ‘Should an agent spend time on you?’. don’t give up the day job. The first is to get a reference book (see below). London: A&C Black. and can usually be recognized by the large number of favourable adjectives: ‘elegant surroundings’. Good advisers will first ask for details of your target audience. Meanwhile. Advertorial Advice on writing You will have little difficulty finding people to comment on what you have written. An alternative technique is to find and bedazzle one at a party: this means joining the kind of group where these people are likely to congregate. You will then have to send in some kind of proposal.THE A Z OF MEDICAL WRITING – Articles that look like objective text. Agents One of the most common questions that would-be writers ask is: ‘Should I get an agent?’.

Annual report of public health Public health departments have to publish an annual report. pleasing none and costing a fair amount of money and aggravation. process of writing). But if they don’t believe you. All this and a foreword from PD James. American English English). which will enable their colleagues to write their chapters effectively. While the best reports give clear. the role of editor for their annual report. using last year’s report as a model (see evidence-based writing). Unless you have a clear idea of the message you wish to put across.AGENTS • The writer’s handbook. or assign to another. A more recent guide. Directors of public health must clearly assume. This confusion has a clear implication. And those who tell you otherwise are ill-informed. edited by Barry Turner. you are merely collecting data and shuffling it around (see leaf shuffling. London: Macmillan 1999. Unfortunately nobody really made it clear why and – more importantly – for whom. with 750 pages packed with similar information. This means defining and communicating the report’s mission and primary audience. considered messages to specified audiences – such as professional colleagues. invite them to look in any contemporary reference work (see grammar booklist). or the Guardian-reading public – many fall uncomfortably between a number of audiences. 5 . This can give problems (see UK–US Amongst with ‘among’? A curiously old-fashioned word. And You are allowed to start a sentence with this word (and with ‘But’). local politicians. What’s wrong Analytical skills These are at the heart of good writing. This in turn should free everybody to get on with some of the better defined tasks in public health.

Why should they (see commissioning)? Apostrophes Rarely does the wrong use of the apostrophe change the meaning of a sentence. When writing a letter. it’s not particularly difficult because its solution is at hand. incompetent and therefore can be ignored. you can target the editor. you can target the decision maker. Article A piece of writing that is published. Apathy A frequent cry among editors is: ‘No one will bother writing for me!’.THE A Z OF MEDICAL WRITING – Antipathy The feeling that readers have for pieces of writing that are over-long. inferring that whoever made it must be illeducated. but is an optional extra: a useful device because it offers readers the opportunity to see the evidence without having to plough through it all. Confuse the two at your peril. Thus ‘it’s colour’ really means ‘it is colour’ (‘It is colour that makes the difference’ as opposed to ‘Its colour is red’). Writers should make every effort to get it right. short articles. When writing a report. forget about learning about possessives and so on (if you don’t know now you probably never will). Simply consider the apostrophe as the top of an ‘i’. you can target the recipient. over-researched. There are two types: those published in magazines and newspapers (see feature article). When it comes to the difference between ‘its’ and ‘it’s’. Audience The person or persons for whom you are writing. This should help you to get it right. When writing for a publication. Appendix Additional material that comes at the end of a report. • Define the audience tightly. 6 . or those published in journals (see scientific paper). If you still don’t understand. But it is an error that some people seize upon with glee. and over-written (see PIANO). ask people who know about these things to check them for you (see grammar booklist). The chances of your work being read increase dramatically if you follow the following two principles. See also review articles.

who are not in a position to argue when seniors demand to be included on the list of authors. Often good advice from the author’s editor is over-ruled. do two pieces of writing. wasting time and money.’ Things look different from the author’s point of view. but the chances of getting the message across will increase significantly. even though the new ‘author’ contributed little or nothing.. you can research what style and structure works for them (see evidence based writing). the system has failed to take off. It becomes much harder to make a piece of writing work when you have to balance the needs of distinct audiences. If you have two audiences. Authorship Over the past few years the question of authorship – whether someone has his or her name attached as a ‘part owner’ of a scientific paper – has become a hot issue.. Although there are some excellent practitioners. Participation solely in the acquisition of funding or the collection of data does not justify authorship. One useful technique is to agree on the number and role of the co-authors before 7 . such as a panel of doctors and a group of patients. it’s the author’s editor. Author’s editors A few academic departments throughout the world employ professional technical editors to help doctors and scientists to prepare a paper for publication. and these principles are of little help to junior doctors. One of the main reasons is that employing someone who knows about writing is helpful only if those who employ them are equally as informed. not the author. And if a paper is turned down. who tends to get the blame. This is because the way editors tend to define it is at odds with the way it is defined by the authors themselves. If you have a clear idea of your readers. Usually they have no choice but to add the name. Authorship credit should be based only on substantial contributions . The time needed to write the second version will be far less than you fear. The Vancouver Group clearly states that each author ‘should have participated sufficiently in the work to take public responsibility for the content. Editors are vehemently opposed to the practice of listing people as co-authors when they have contributed little or nothing (gift authorship).AUDIENCE • Separate distinct audiences. This is probably one of the great principles of effective writing.

These are those pieces of writing that you gamely wade through. Bad writing I take a pragmatic view and define bad writing as writing that fails to get the desired message across to the target audience (see brief setting). Autobiography Great to do. for doctors. and until the system is reformed conflicts will exist between those who want some easy points (and perhaps get back to their proper jobs) and editors who feel that this is somehow not playing the game. • The language is inappropriate. The sentences don’t seem to follow on from one another. the current trend is for journals to add lists explaining who did what. not true (see scientific fraud). This can be fixed relatively easily. There is absolutely no defence for this. If this is the style of your target journal. then follow it (see evidence-based writing). Four types of errors may get in the way. the arguments depend on facts that appear to be. if the will is there. alas. less obviously. but by the 8 . The real cause of the trouble is the fact that authorship is now one of the main international performance indicators for scientists and. • It is difficult to follow the argument. Meanwhile. The author has chosen words and constructions with which the audience is not familiar (see jargon). The writing may read easily and appear plausible but. There is no reason to believe that the ability to publish in an English language journal should predict the clinical performance of a Dutch doctor. This can be fixed by altering sentences and paragraphs. so that readers find it difficult to understand what is going on (see structure. don’t expect others to be interested (see vanity publishing). • It’s wrong. but that is currently a fact of life. though it takes considerable time and is difficult to do well. • It leaves the reader wondering why it was written at all. This should limit the practice of people jumping aboard once all the work has been done. See also ghost author. or later turn out to be.THE A Z OF MEDICAL WRITING – the article is written (see brief setting). yellow marker test).

and the writing will be doomed to fail. and you should be able to find at least one area where the writer has done well. Balanced feedback 9 . broadly speaking. first establish the audience for which is intended. When people ask us to comment on their writing. Is it a reasonable message? And is it appropriate for the audience? • Is the writing structured in an appropriate way? Did the writing keep your interest or did you find yourself flagging? Were there places where you had to go back and start again? • Is the tone appropriate? Ask whether the style is. after which you will be in a position to make up your mind on the following key questions. If the writer cannot define a clear message. Balanced feedback is a simple technique that allows us to improve the writing without wrecking the writer’s morale. For example: ‘You have a clear message. drawing attention to what you think is already good – and what you think the writer needs to work on. Whenever you are asked your opinion on a piece of writing. but don’t worry too much at this stage about individual points of style. Even under these circumstances I would urge restraint: would it really make a difference if you didn’t have your way over style every time? (see macro-editing. These are macro-editing issues. • What is the message and is it right for the target audience? Is the message in an appropriate place (look in particular at the first and last sentences). we tend to shower them with criticism (see correcting the work of others). The argument became a little difficult to follow between the fifth and eighth paragraphs – and you may wish to insert some key sentences so that the reader can see why you have included this information. You will have put them in context as fairly minor amendments (or nit-picking stuff). You have written it in an appropriate tone. micro-editing). Read the piece quickly. which is interesting and well worth putting across to your target readers. message). Here the various readability tests will come in useful.BAD WRITING end have no idea why (see brief setting.’ If you still wish to deface the text with detailed changes (microediting) you can now do so. Write a short note. then the reader will be unable to. appropriate.

Here are some tips. though sadly the knowledge in them is not transferred unless they are actually read. Under grammar. Book reviews Follow the same principles as for review articles. A piece of writing that puffs itself or praises another. where one person will find it difficult to keep in touch with all the developments in even a narrow specialty. I suspect that few people make much use of them. Those chosen may not have to spend hours researching topics just below the horizons of their immediate knowledge. there will be a short selection of books. there is a good case for multiauthored books. arrange your schedule so that you can write during these periods: your writing is unlikely to be fresh and attractive if you are fighting an overwhelming desire to take a nap. If possible. Block Blurb See writer’s block. for instance. This book does not have a booklist at the back. Science journals increasingly carry blurbs (or short summaries of interesting articles) on an early editorial page. Books. 10 . The purpose of these is to whip up interest and entice readers to keep turning the pages. editing of In a fast-changing world. Booklists A kind of fashion accessory. for reading and reference. but they will have a host of other problems. as on the outside of this book cover (I hope). Instead I have chosen one or two books from my bookshelf and will recommend them at the appropriate point. Books. but keep them shorter. But someone has to edit them. work out the best times of the day for you in which to write. buying of To be encouraged.THE A Z OF MEDICAL WRITING – Biorhythms If you need to do a lot of writing. without which it appears no self-respecting book should be published.

Establishing a good relationship with the commissioning editor at this stage will pay off later. Have a fallback plan – for instance another author standing by – for the inevitable authors who fail to deliver. and that you are happy with it. but what’s in it for you? And what can you give up to make the time? • Establish good relations with the publishers. Editing takes up huge amounts of time. • Thank the contributors.BOOKS EDITING OF . make sure that you have a clear proposal from the publisher. the amount of practical support (e. and sorting them out so that they do. Do not over-negotiate. and decide who you want to cover them. • Make explicit plans. but there is still an important role for the editor in reading the submissions.g. Before you invest your time. and (particularly important these days) electronic rights. in what form and by when. Consider lunch. Write down clearly what you want them to achieve (see brief setting). Make sure they know what the other contributors are covering and who the audience will be. Work out a timetable. letters to contributors) that the publishers will provide. Publishers will want their own technical editors to have an input. • Collect the chapters and do some macro-editing. This is an illusion. Keep an eye out for unfair criticism of the work of rivals (see defamation). • Support the contributors. Make sure everyone knows exactly what you want them to do. you may need to dig deep into your reserves of tact and diplomacy. You should build in some support for your writers. You may wish to take advice from a lawyer or (if you are a member) from a group such as the Society of Authors. Work out what topics you will need to cover. • Be absolutely clear that you want to do the book. Make sure everything is in writing (see commissioning). all they need to do is to pen an elegant introduction. Many editors feel that once they have briefed their contributors. • Brief the contributors. so it is common courtesy to thank them as soon as they send in their chapter. It is flattering to be asked to edit a book. Don’t rely on your own network: literature searches will enable you to locate acknowledged experts. with a follow-up letter and a copy of the 11 . otherwise the chances are you will reach the final deadline with no copy submitted (see apathy). allowing plenty of slack for slow writers. such as a telephone call. Issues to clarify include the nature of rewards for you and your contributors. Give clear deadlines. Most will have spent time and effort on your behalf. and will eat into the rest of your life. making sure that they meet the intended purpose and standard.

THE A Z OF MEDICAL WRITING – book once it is published. keeping a copy in the drawer. There are many good reasons why you should under no circumstances write a book. • Accept your first contract graciously. after reading this. 12 Books. if you decide to do another book. At the end many editors feel that they have written it all themselves. It is a painful activity. add supporting information. It eats time (as a rough guide equivalent to three months of a full-time job). You may wish to consult a lawyer or the Society of Authors. during which writers become deeply antisocial. Now try to obliterate any trace of it from your memory until you receive the reply. Your contract will almost certainly offer substantially less than you think you are worth. • Gain from the pain. or a CV. you can afford to take a more muscular line. If. Include a list of chapter headings (for non-fiction) or a sample chapter (if fiction). Even if you think the publisher has made a dreadful mistake (and it does happen: George Orwell’s manuscript for Animal farm was rejected on the grounds that it is ‘impossible to sell animal stories in the USA’). etc). (After the extraordinary success of your first book. You will also need a covering letter. such as articles you may have written. so learn from rejection. It is difficult to find a publisher. UN expert on pagination. The first thing to do is to have an idea. then you probably should. alternatively you may wish to take the view that publishers are doing this all the time. consider whether you could and should make changes. • Identify a suitable publisher. and as a newcomer and first-time author it will be unwise to rock the boat. Go to a bookshop or use the Internet to browse. writing of . Sometimes they have. then construct a proposal. you still want to continue. and want evidence that you are likely to do it well. Send everything off. Apart from anything else. Publishers are interested in good ideas. Then ask the key question: will enough people be interested enough to spend money on buying it? If you still wish to keep going. and out of proportion to the work involved. Finally. Start with a brief description (200 words or so) of what you intend to do and who will buy the book. however. giving perhaps one or two reasons why you think you should be trusted (author of 17 other books. follow these stages. you will need some good and loyal writers. The financial rewards are usually low. and send it in. Most people fail at the first attempt. professor of book writing.

This doesn’t mean to say that copy editors are infallible. more importantly. • Sit down and plan. If you think every proposed change is an insult to your great talent. letters of 13 . or your weekends in the garden? (see time management). or your mornings in bed. Then put down some deadlines for the actual writing: how many of your 50 000 words do you intend to write a month? And.BOOKS WRITING OF . Do all you can to help during the marketing phase. expect changes. evidence and a reasoned argument (evidence-based complaining?). It helps if your editor still has positive feelings towards you when you send in your manuscript. After about six months the book will be published – and there will probably be an anticlimax. Most publishers like a ‘clean’ disk (i. or do you end the relationship and try to find another publisher? • Enjoy the publication. you are either being unrealistic or are with the wrong publisher.e. if that is your style. above all. like me. simple text without designed tables and boxes. • Keep in touch with your editor. You then have a simple decision to take: do you negotiate. and for doing the tricky administrative things like seeking copyright. But this does not necessarily mean that you have to write it that way. Now is the time to await the plaudits and the cheques. Work out when you have to submit the manuscript and put the key dates in your diary. Your publisher will have been involved in many more books than you have and will be better attuned to the target audience. If. Both will offer meagre fare. Don’t be afraid to ask for advice: it is better to sort out problems early rather than haggle over them at the last minute. • Find out how your publisher would like the copy to be presented. do so with tact. so that their own copy-editors or designers can do the formatting (or ‘marking up’) themselves. but if you do disagree. charm and. italics and bold are normally translated easily into other systems). employ an agent and screw the publishers into the ground. • When you finally send the manuscript off. you are one of those people who need to fiddle with the way your writing actually looks (see layout). Work back: allow time for rewriting. Also allow time for other people to look at the manuscript. when? How will you find time – do you plan to give up your evenings at the gym. feel free to do so. Your friends will say (to your face) that the book is wonderful (and then drop hints about a free signed copy).

that will give you about £1500 (less tax) if all copies are sold. Approach the project as you would any other writing task (see process of writing). You are unlikely to get paid. Saying no at this stage will be appreciated: publishers say that their biggest problem in multi-authored books is dealing with the delays caused by those who keep insisting that they want to contribute. and then consider whether you really want (or need) to invest the time. This is stealing. say. like mountains. Borrowing other people’s ideas do it (see copyright. but it’s hardly rational behaviour. But even single chapters require a major investment of time – a week’s work or more to do it properly. Boredom We often experience this when reading what others have written. and that throughout the writing 14 . but never get around to doing so. and sometimes dangerous. and use the structure of a feature article for each section. As for the money.50. 2000 at a price of £12. Books. make sure you display it prominently. The real point about writing books is that. Hardly a good return on the huge effort you made. we never expect our readers to do so when reading our work. you will probably have signed a contract for 12. Some of us cannot resist the challenge. Your main reward will be satisfaction of a job well done. Do not Bosses Some are marvellously helpful when it comes to giving balanced feedback on what we write.5% net of the royalties. You should be offered a free copy of the book.THE A Z OF MEDICAL WRITING – praise from unknown admirers are less likely. Others are discouraging. plagiarism). they are there. With a print run of. Be flattered by the invitation to contribute. Curiously. writing of chapters in One of the great advantages of multi-authored books is that they meet the huge demand for authorship. Divide the chapter into manageable chunks of 1000 words or so. and if so it will rarely be above £200 a chapter. Remember that bosses can turn into a powerful false feedback loop.

Branching Branching techniques. Write the message in the middle of the paper (‘All writers should buy a treadmill’) and then start asking questions (‘What kind of writers?’. ‘How should writers use it?’ ‘How do we know it helps?’ and so on). such as spidercharts and mindmapping. The advantage of this. All you need is the message. a large piece of paper with at least one pen or pencil (some say more) and 5–10 minutes. At its basic level we can use this method to compile a list. You will. and when you come to the end of one train of thought you should go back to the message in the middle and start again. 15 . say. be able to distinguish between matters of substance that must be included. Brainstorming techniques try to circumvent that in the planning stage by encouraging us to put down our thoughts on paper – as they come and without stopping to criticize them. Brainstorming Throughout the writing process our tendency to criticize can overwhelm our capacity to be creative. This is a breakthrough. and detail that could be included if space permits. Each question should lead to others. but as soon as you have something down you can start to control it. as one course participant once put it. Within minutes you will have a page covered with words. Breaks Locking yourself in a room for three hours at a time is unlikely to boost your creativity. all coming out from the message in the middle. a system developed by Tony Buzan (see process of writing booklist). Try to write in short bursts of. play an important part in the writing process – in particular. and make sure that you really are writing and not worrying about what you have just written (see free writing). is that the mess in your head is now the mess on a piece of paper. A development of this is branching (see below) where we allow our thoughts to spill out all over the page in a much freer way. All will be related to the message. at the stage when you have decided on your message and need to collect and arrange the information needed to prove it. A sophisticated version of this is mindmapping.BOSSES process our duty is to argue – tactfully – for the interests of our target readers (see negotiating over copy). Committing yourself to putting things down on paper is one of the hardest parts of writing (see writer’s block). for instance. ‘What kind of treadmill?’. 10–15 minutes.

If it looks as though you will have to please two separate audiences at the same time – such as a report 16 . without really knowing where we want to end up. • Message.THE A Z OF MEDICAL WRITING – Nothing benefits a piece of writing more than the temporary leaving of it. If you want to write an article. Decide for whom this message is intended (audience) and how you intend to get it to them. originally recommended in Medical journalism. As long as it remains rumination. For instance: ‘Wearing sandals with socks reduces the incidence of athlete’s foot. Be specific: the more tightly defined your audience. It will also distinguish it from a title. not procrastination. the writer’s guide (see Journalism booklist). in which I advise that the first thing to do is to draw back from writing – and to think very carefully about what you want to do. It involves taking time to think about what you want to do. you should not worry. but look at the existing navigation charts before you set out. etc. As for what you need to think about. write for the main player in the decision-making committee. write for those who will have to carry it out. See also time management. This is the message. these are contained in the following five points. with more difficult pieces of writing you may need days or even weeks. for instance. Some people start by writing lists. the greater your chances of success. ‘does not affect’. others go straight to a word processor and start writing down what comes into their heads. I call this stage ‘setting the brief ’. and should take the form of a simple sentence of about 10 words. If you are writing a procedure for a new clinic’s appointment system.) which gives it direction. If you are writing a report justifying the purchase of an expensive piece of equipment. do more research or more thinking or both. ‘increases’. Work out the most important thing you want your readers to take away from your writing. Brief setting One of the great mistakes we make when writing is to start too early. Do not settle for a question: if you do not yet have the answer. By all means let your writing be a voyage of discovery.’ The key is to include a verb (‘reduces’. I recommend an alternative step. • Market. which (in journals) usually consists of a string of nouns (‘Footwear apparel and fungal infections of the skin and nails of the feet: a randomized placebo-controlled trial’) that will not make a suitable starting point. or Country Life?). You may be able to do it in less than a minute. define which journal (The Lancet.

• Payoff. This will be based on the multicentre SOLE trial and will comprise 500 words. Now work out what you need to please your audience. who may subsequently want to comment on your piece of 17 . • Length and other aspects of style. ‘A report for the management board arguing that sandals and socks should be issued to all staff in order to reduce the incidence of athlete’s foot. but by whether our writing has enabled us to achieve what we set out to do. inserting second-level deadlines for the major steps you need to take on the way.’ • Task 2. irrespective of whether we have split the odd infinitive. such as bosses or coauthors. we have also succeeded (and subsequent gripes from rivals should be seen in this context). revised by August 15. Define how you will judge the success of your writing. This should not be determined by how you rate the importance of the topic (or happen to know about it). and we manage to do so. The writing will be considered successful when staff get issued with their regulation socks and sandals. • Deadlines. Now we are established in our careers. but on what the market should bear. our writing has succeeded. The first draft will be completed tomorrow. both on the subject of socks. The primary audience will be the director of human resources. For instance. The report will consist of one sheet of A4. ‘A research letter for The Lancet showing that sandals and socks reduce the incidence of athlete’s foot. and revised the following day. if we are trying to get a paper published in a prestigious journal and it is accepted. examinations). Decide on the length of the piece of writing. measured in words or paragraphs. if we are trying to attract a £1 million grant. The article will be written by August 1. Take your time over brief setting. Similarly. Then work backwards.BRIEF SETTING on the latest research for members of a patient group and interested doctors – then write two different reports. The writing will be considered successful when the editor accepts it for publication. Consider the following examples. sent out to co-authors on September 1 and submitted on September 21. Set the date by which you need to finish the writing. Too often we judge it in terms of half-remembered notions of literary criticism (see English teachers. we should regard writing as a tool not a test. You may not believe it at the time.’ A useful trick is to make sure that others. but having a clear idea on the above five questions will make all the difference to what you are setting out to do. and therefore judge success not by the details. shoes and athlete’s foot: • Task 1.

• until you get to the last point. Byline The name of an author on an article in a newspaper or magazine. show them the brief. though they are still used for months and days of the week.THE A Z OF MEDICAL WRITING – writing. They need no longer be used for seasons. all of which are roughly as important as the others. and • you expect your reader to be skimming what you have written. They become less useful when you want to persuade or lead your readers through a complicated argument. or of a proper noun such as Aylesbury or Zimmerman. 18 . Do not use them on the grounds that they make the word look more important (see pompous initial capitals). Agreeing on the message and the market at this early stage can save endless arguments later on (see negotiating over copy). There is a trap when it comes to punctuating bullet point lists. Strictly speaking the bullet is not a punctuation mark. so you should ignore it. or perhaps feel that your reader could do with a little entertainment. Capital letters These should be used for signalling the beginning of a sentence. A list should therefore start with a colon like this: • not followed by a capital letter and not ending in a full stop but in a comma or semicolon. Don’t wait for the finished piece. They are useful when: • you have a small number of discrete facts. Bullet points Bullet points are currently fashionable. see these details before you start. Getting one of these can be a major incentive (see commissioning).

The levels of pay are likely to be less than one would expect as a doctor. or it could mean a period of apprenticeship within medical writing. use the yellow marker test to study the structure. This could mean a full-time course for a year. working as a writer on a medical newspaper or producing marketing material for pharmaceutical companies. 19 . Case reports In the past these were a good way to get your name on the databases. Writing professionals tend to be less hierarchical. But being a doctor will not in itself qualify you to write about medicine. You now have to look around carefully for a journal that will take them. which will vary from journal to journal. Then approach this as you would approach any written work (see process of writing). and the demand for case reports is much less than the supply. so that one week later (the next doctor) or five years later (the lawyers) will be able to reconstruct exactly what happened. You can see what you produce. writing of chapters in. Think carefully about whether you have a suitable case – look in particular for a good message that will have immediate clinical relevance. Tell the truth. and the hours tend to be more civilized. When you find one. and can measure your performance (see effective writing). yet they are difficult to do – and are often done badly. Unfortunately the current trend for larger and larger statistical samples means that they are currently out of favour among editors. writing of See books. For further information contact doctors who are already working in these fields. Case notes Doctors are writing these all the time. These include working as an associate editor on a scientific journal. such as the patient whose rash on the inside leg turned out to be a rare case of hepatitis M. Chapters. and write clearly. and indeed working as a writer has a number of good points. Tell the story. It is tempting to look at these as an escape route from the demands of patients and colleagues. and you will need to acquire some extra skills.CAREERS IN WRITING Careers in writing A number of jobs combine a knowledge of medical matters with an interest in writing.

But don’t over-egg the pudding. But obsession with detail can obscure. but an interesting or important message.THE A Z OF MEDICAL WRITING – Checking facts This is important. Checklists Christian names This term is inappropriate in today’s multicultural societies. Citation index See impact factor. ask yourself whether something more original would be a better choice. at worst tiresome. if you see a familiar phrase. avoid choosing clichés that will cause your target reader (though not your false feedback loop) to ridicule you. Use ‘first names’. Good writing is not just a succession of facts put down in a plausible order (see leaf shuffling). These are useful up to a point (or first 80 points!). And some. from publishers to methodologists. However. So pay particular attention to things that matter: dosages. for instance. or names and titles. On the other hand. Second. or drive out. produce checklists to use when writing papers and reviews. the nature of writing is such is that it is almost impossible to achieve 100% accuracy. All kinds of people. but those who know will lose confidence in the rest of your writing – and gleefully tell others of your shortcomings. have their own technical use among certain groups (see jargon). Often it makes little substantive difference to the main thesis (Mr William Browne will have been sacked from his prestigious post regardless of the fact that you have left the ‘e’ off his name and have called him Mr Brown). and means a phrase that is reproduced so often that it is at best unoriginal. Clichés The word comes from the French term for a printing block. Clichés make splendid targets: for instance ‘the focus on a fundamental shift in the culture of learning. like ‘ownership’ and ‘mission statement’. Don’t feel you must get rid of them all: I have deliberately used several throughout this book. supported by evidence (see truth). leading to empowerment and a win-win situation’. 20 . some phrases. like ‘moving the goal posts’ and ‘gold standard’ are a kind of shorthand that allow us to put across a familiar idea quickly and easily. sensible messages. So what should the writer do? First. And don’t become suicidal when the occasional error creeps in (see law of late literals).

Follow the example of successful sports coaches – and celebrate whenever you achieve your goals. by Joan Bolker. • Tactics. Encourage them to sit down and work out why they need to write. All too often people who write find that their only ‘reward’ is a mass of minor textual criticism. • Execution. Meet regularly to ensure that the deadlines are being met and. New York: Henry Holt. • Writing your dissertation in 15 minutes a day. 1998. Many people feel that they should be writing (scientific papers. but probe with open-ended questions so that writers can develop their own ideas. • Strategy. When (and if) the time comes for you to look at the manuscript. Coaching is an alternative approach. based on the assumption that people do best at a task if they are allowed to get on with it themselves. get them to commit to the what and the when (see writing goals). And give priority to keeping the copy moving: nothing demotivates more than to have work sitting in someone else’s pending tray. Set deadlines. BOOKLIST: coaching • The coaching pocketbook. work with the writer to find ways of getting the work moving again. Coaching can be of value at four different phases. Ostensibly for those who are setting 21 . Look for whether the writer has clearly defined the audience. This approach is not necessarily taught in medical school. Once the writing process has started. 1998. Question how the writer will judge success (see payoff). • Reward. Alresford: Management Pocketbooks. Encourage writers’ support groups. for instance. In the light of this. Entertaining and versatile. and instead offer support and encouragement. if not. provide support and encouragement. This is not normally considered the best way to develop and motivate people. for major factual omissions or for potential political problems? Give balanced feedback. Too many people launch themselves too quickly into a piece of writing. for instance) but aren’t quite sure how. Encourage them to take time to ruminate. ask why you are being asked to read it – for silly mistakes. to set their own brief – and provide support at this early stage. Encourage research on the market as well as the topic being written about (see evidence-based writing). Those with more writing experience should resist the temptation to give a mass of ‘corrections’. Don’t criticize. Create a culture where winning – as defined by the writer in advance – is celebrated. by Ian Fleming and Allan JD Taylor. part of an excellent series that also includes books on time management and personal development.COACHING Coaching.

this is perhaps even more useful for supervisors. If all co-authors have agreed on the deadlines. • Arrange a meeting at the beginning of the writing process. Keep them in touch with what you are doing. this will enable everyone to identify those who are slowing the process down. Co-authors As a general rule. more important still. the greater the problems. Far more important is the support and advice received as you are preparing the various drafts. Some interesting thoughts on setting up writers’ groups. Send coauthors regular updates of progress. who believe that they are failing if they are not pumping out as many criticisms as they can think of. Co-authors need to have a ‘substantial intellectual involvement’. you have a lever which may help to move the laggards. the greater the number of coauthors. and encourage them to play the role of coach rather than critic. • Judge any comment from a co-author on whether it is more – or less – likely to get your paper published in your target journal. Sometimes a bit of naming and shaming will help. Lay down deadlines. what they will do. by Roy Peter Clark and Don Fry. The manuscript over which you have been sweating for months is torn apart by others. The poor author is then left. many of them conflicting. Some people will always sit on a manuscript. and in which order they will appear on the manuscript (see authorship). One of the major problems at this stage is the mass of conflicting advice as each co-author proposes amendments on his or her notion of what makes a ‘good’ paper (see Icarus fallacy). • Coaching writers: the essential guide for editors and reports. • Circulate the timetable among the co-authors. manuscript and confidence in tatters. Agree who the co-authors will be. agree on the target journal and. 1992. and this is really the time you need sensible input from your colleagues. You will be pleased to know that there are some techniques that can ease the pain. but this does not necessarily mean detailed textual criticism once the work has been done. An interesting book from two journalists in Florida with important lessons for those working with writers. The sensible way through this is to judge these comments on whether they are more 22 . get everyone to agree what the message will be (see brief setting). New York: St Martin’s Press.THE A Z OF MEDICAL WRITING – out to write a thesis. • Involve your co-authors throughout the process. with a pile of alternative suggestions.

though your word processing package may not know this (see semicolon. • Try to steer your co-authors into doing what you want them to do. • Do not be bullied into doing what you think is wrong. Being criticized seems to be part of the publications game. Instead of saying ‘Please let me have your comments’. ‘I enclose the draft of this article which. Under no circumstances should you give in to pressure from co-authors to do anything that you think is morally wrong. try. In US English usage it is common to have a capital letter after the colon (‘He wanted three things: To visit every hospital in Poughkeepsie. Colon A punctuation mark that denotes a major pause that comes before an explanation or elaboration. celebrate. Discuss those that are clearly counter productive (see negotiating changes). and learn how to use chopsticks’). as in. Keep reminding yourself that you are making progress and that this is one of the last major obstacles. or ‘massage’ the figures to make the work look better (see scientific fraud). Colon dash(as in :-) be used. such as make up patients who did not exist. Can you let me know if you see any major omissions?’ (If you have been keeping people involved (see above). and if you are unlucky enough to be involved in such a situation. Don’t be demoralized. and you become published authors. This can be easier said than done. write a book review for the New Yorker. If you survive your relationship with your co-authors. UK-US English). ugly and should not 23 . then perhaps you can try: ‘Can I assume that you are now happy for me to send it off?’) • Don’t take it personally. as you know. This is not the case in UK English. These are archaic.CO AUTHORS - – or less – likely to increase the chances of publication (see evidence-based writing). has been targeted at The Lancet. It will make all the aggravation and humiliation seem worthwhile – until the next time. seek a wise head for immediate confidential advice. ‘I am telling you something important in this section: it is how to use the colon appropriately’. which is an open invitation to be destructive.

particularly among medical journals. have a clear idea of what you want: it is not helpful to give a long list of points that you wish the writer to include. to be parsimonious with the comma. zebras. technical points (such as whether you want the article to be sent by e-mail) and payment or other reward. This does not happen in US English (‘stethoscopes. and went’. which should cover the following questions. and chairs’). editing of). the hard thing is to find someone who will do it well (better than you. Commissioning editors usually make the first contact by phone. instead describe what you want the article to achieve. Hardest of all is getting that person motivated. If you think the writer is unfamiliar with the publication. This is because in UK English the comma is dropped before the ‘and’ (‘stethoscopes. rushed to their lawyers)? The use of commas in lists can cause confusion. Commas are important. so the ability to persuade good writers to contribute is an important skill (see books. send one or two back copies. who had demanded compensation. who had demanded compensation rushed to their lawyers’ is ambiguous. 24 . in which case they should always travel in pairs. Also discuss deadline. write a follow-up letter. There is a fashion. If you are commissioning. Having an idea for an article is relatively easy. Does it mean that a group who had demanded compensation went to their lawyers while another group stayed put (‘The patients who had demanded compensation rushed to their lawyers’)? Or does it mean that a group of patients had rushed to their lawyers and all of them were demanding compensation (‘The patients. • What kind of publication is it? The writer should be clear about the goals of the publication – and about its audience. and of other interested people’.THE A Z OF MEDICAL WRITING – Commas A punctuation mark that indicates a slight pause: ‘He came and went’ is different from ‘he came. Once you have agreement. ‘The patients. This can cause difficulties for the reader (see grammar booklist). and can cause all kinds of howlers when omitted or wrongly placed. zebras and chairs’). as in: ‘The society is made up of those who experience difficulties in digestion of their relatives. otherwise why bother?). One of the big problems occurs when commas are used to make a separate and self-contained point. Commissioning The success of most publications leans heavily on the quality of its contributors.

by phone. • How much you will pay (or any other reward)? Nobody does anything for nothing so what will be in it for the writer? Spell out the reward in your letter. In such cases you may wish to offer a slightly lower amount as a kill fee. e-mail. Alternatively you can reject it. Commissioning editors. Many articles disappear into black holes. Make sure that it isn’t so tight that failure to meet it will leave you in a completely impossible position. with authors getting feedback only when someone tells them they have seen the article in print. You have a duty to be polite when rejecting an article. If you have done your job. Anything written in committee usually ends up being written for the committee (or rather the powerful figures within it). letter or in person. who may wish to submit it elsewhere (see rejection). and usually crave reassurance it has been worthwhile. If you decide that the article is not what you want. not for the target audience (see false feedback loop). Committees Keep them as far away as possible from the writing process. and it should be realistic for both of you. you can ask the writer to try again (in which case you have to be specific about the exact things he or she needs to do). in which case you have a duty to return it as quickly as possible to the author.COMMISSIONING • Where in the publication will it go? Knowing exactly where it will go will help the writer to do such basic things as write to length and ensure the right tone. • Who will own the copyright? This is a controversial issue nowadays and some editors may feel safer leaving this out and hoping for the best (see copyright). should always say thank you. • When do you need the copy? You should have agreed this verbally. Writers spend long and lonely hours. • What do you want the article to do? The writer needs a clear confirmation of the subject matter and broad intent. 25 . by the time the deadline comes you will have exactly what you want – or better. but you do not have to justify yourself at great length: sometimes things don’t work out. Now should come a frequently neglected step. therefore. so that he or she can start to work out an appropriate message (see brief setting).

a writer sends a message that must be read – and understood – by the target reader. a basic reader-centred model will suffice. With this model. Compromise See negotiating changes. In such cases the solution is to print out a copy and do your rewriting on hard copy. The first thing is that you are no longer writing for yourself or your colleagues (see false feedback loop). The second is that it allows people to sit and fiddle with what they have written. This will at least allow you to have a sense of progress. . It may sound simple but it has some important implications. Computer screens 26 If you cannot write a sentence without going back and fiddling with it. however. If you want to break into these markets. it will bring your writing to the attention of an editor. Computers. This leads to two major problems. You can write in such a way to increase the chances of this happening (see evidence-based writing). For effective writing as defined in this book. often because they are an excellent way of finding new talent. and this could be the start of a mutually beneficial relationship. Writing something down does not guarantee this (see effective writing). You have a way of judging success: ‘Did the target audience read it?’ (see effective writing). The first is enticing people to write too early (see premature expostulation). Even if you do not win. such as knowledge. context and motivation. watch out for them and enter. turn off your monitor (see free writing). Competitions From time to time publications run writing competitions. writing on One of the great drawbacks of computers is that they can take much of the pain out of writing. Communication theories Communication is a complicated business and there are all types of theories that take into account a wide range of factors influencing all those involved in the process.THE A Z OF MEDICAL WRITING – Communication Getting a message across from one person to another.

so these reports are neither a précis nor a set of minutes. formulate a message and then choose to put in only the information that will support and elaborate that message. Yet these tend to be the ones who argue loudest in favour of long and flowery words and phrases. Look also at the topics dealt with in the past. try to find something that will develop these ideas and discussions. Perhaps concise writing is something they have been told they want. Avoid also using the shape of a scientific article (see IMRAD structure). Unlike the abstracts published alongside a scientific paper. they will earn you an invitation to produce a poster. • Get a good brief from the start. Conference abstracts Those with ambitions to travel and to advance their knowledge and careers need to master the art of the conference abstract. Study the structure of previous abstracts. This sounds a straightforward task. they stand alone. You clearly cannot cover everything and everyone. Approach conference abstracts as you would any other writing task (see process of writing). Which publication and what kind of audience? What 27 .CONCISE WRITING Concise writing I find this a puzzling concept. to be published in the conference abstract book. but isn’t. the writer’s task is to cut them down to about 1000 and arrange them in a way that will attract the uncommitted reader. Many people who come on my courses say they want to learn how to write more concisely. Avoid clinging to the order of the conference proceedings (‘In the early afternoon we heard an excellent presentation on sentence construction before moving on to the future of the paragraph after tea . Conference reports Those who attend conferences are often asked by those who don’t to ‘write it up’. or present a paper.’).. but don’t actually want it (or value it) themselves (see false feedback loop). It also means looking at the material from last year’s conference.. Prefer the feature article structure: from all the information you will have collected. In particular research carefully what the organizers want: this means looking carefully through all the advance material you can get hold of. The main problem is that these conferences churn out thousands (if not millions) of words. Make sure you get detailed information from whoever asks you to write the report (see commissioning). If you are lucky.

but look at notice boards. and (2) to accomplish. don’t be afraid to do it. and (2) to raise or increase. Lack of data is rarely the problem. and if so by whom. such as an expenses-paid trip to Monte Carlo. decide on a message. This is not a shopping list but a brief account. they lose their usefulness (see Pravda effect). Similarly. Here is a sample: • affect and effect: (1) to influence. many papers in scientific journals make it clear if the work has been supported by the pharmaceutical company whose product is being tested. A great way of travelling to foreign parts (see conference abstracts). Conflict of interest Many travel articles are followed by a brief statement stating whether their tickets have been paid for. If there is any reason for anyone to suppose that bias could take place. Conferences Gatherings of the professional tribes. then it must be declared. Confusing pairs Some words are troublesome because they sound the same as other words (see homophones). exhibitions and anything else that takes your fancy. the difficulty is how to order it. 28 . start with the basics: construct a 12 word message from the conference. usually at someone else’s expense. others give trouble because they are confused with other words that sound different – but not too different. As with all types of writing. • Don’t be afraid to leave things out. What’s new? What’s interesting? What would the readers like to hear about? • After the conference. What some might call bias is necessary selection. and are not being expressed for other reasons.THE A Z OF MEDICAL WRITING – format? Is there an example of the kind of conference report they like (and perhaps one they don’t)? • At the conference. then go through the usual stages (see process of writing). Failure to do so looks suspicious. Don’t just listen to the proceedings. The point is that readers have the right to assume that the views expressed in an article are honestly held. • alleviate and elevate: (1) to lessen. At the same time try to make sense of it all. just soak up the information. If publications are not trusted. These could provide detail and colour to lift your report out of the mundane.

up to a point (see lawyers). (1) lying down.CONFUSING PAIRS • continual and continuous: (1) very often. pass the buck swiftly to your publisher. First. correct grammar and spelling. Controversy Editors realize that there is nothing better for readership than a good row. and to point out infelicities (such as. you must seek permission if you want to use substantial pieces of text. my failure in the first draft to give copy-editors an entry of their own). often badly. Copy-editors People used by book publishers (mainly) to put text into house style. will make the money their brilliance deserves. and (2) unbroken. can ensure that they. particularly those working on their own. They can perform invaluable services. See also technical editors. and (2) male gland. and the new freedoms of the World Wide Web will make it more so. so this task is fairly straightforward. if your idea is 29 . (2) to forbid. I suspect that this is one of those areas where the amount of effort (and loss of goodwill) is usually outweighed by the actual amount of money involved. • prescribe and proscribe: (1) to suggest a course of action. in this case. So they welcome controversy. • prostrate and prostate.). charts or tables from another article. The simple answer is that. and not their publisher. The precise definition of the word ‘substantial’ keeps many lawyers and their family in luxury. as in ‘Where’s the bloody copy?. This has always been difficult. so if in doubt. There are two ways in which it affects authors. Copyright This establishes the creator of a piece of original work and protects authors against others stealing the idea or making money out of copying it. Copy Journalists’ term for a piece of writing. • flaunt and flout: (1) to display ostentatiously. Most publishers ask authors to assign the copyright to them. and (2) to display contempt for (the law etc. Then there is the question of how authors. subeditors.

Correcting the work of others We often use the word ‘corrections’ to describe the marks that other people have put over what we have written. who can carry out these unpopular arguments on your behalf. Court action Best to avoid (see lawyers. it could be a matter of life and death (see proofreading). In some cases. but also from a range of other things – for instance. and the covering letter offers an excellent opportunity to make a good impression from the start. In particular you will have the opportunity to establish three things.. and even the style (friendly. illiterate?) in which you phrase 30 . In fact they are usually changes... These can be identified quite easily with the first six words test. ‘It was so nice to meet you last Saturday’. ‘our team has already published in your journal’. the convention is to start with a polite cough in the first sentence: ‘Thank you so much for your kind letter . Covering letter Presentation is an important part of the battle to impress an editor. the typeface that is chosen and the way it is presented. with letters.’) that could be moved to the end of the sentence or even cut out altogether.. However.. and mistakes are inevitable (see law of late literals). In fact it was in East Sheen. such as publishing an incorrect dose. such as. Editors clearly have a duty to their readers to correct information that has been proved to be wrong.’ In other cases. pompous. This comes partly from your name and title at the bottom of the letter. the formal stationery on which the letter is written.. Coughing The habit of starting a piece of writing with some weak words (‘It is interesting to note that .’ or. and not corrections (see balanced feedback).THE A Z OF MEDICAL WRITING – that good. this is relatively trivial: ‘In yesterday’s obituary we said that John Brown-Green died in a car accident in Barnes. written cues. libel). ‘Some observers have noted .’. • Who you are. Corrections Publishing anything is a complicated business. then you should immediately get yourself an agent.

bribes (‘I hope that you will be our guest at our next congress in Rio de Janeiro’) and sycophantic appeals (‘I am a regular reader of your excellent journal’). Avoid the formulaic ‘Enclosed please find herewith my paper Letters to the editor: a multicentre double-blind trial. But you may wish to drop in the fact that your research gives the next step in a series of findings published by the journal. Avoid veiled threats (‘I am a member of the disciplinary committee of the Royal College of Medical Communicators’). the covering letter to the editor will also have a number of formal requirements. require all co-authors to sign. or that it genuinely adds to the debate on an important topic. • What you are offering. you may wish to enclose some cuttings of previous articles you have had published in similar publications. will give you the best of both worlds. wouldn’t they? Crap A useful term in certain circles to describe a piece of writing that does not work. Sell your message: ‘I enclose a copy of our paper which proves for the first time that writing covering letters of more than 200 words increases dramatically the chance of being published. Creativity In general we can favour this. 31 . If you feel brave. for instance. This does not necessarily mean that the writer is a failure. Carefully read the Instructions to Authors to see what is required. • Why the editor will benefit from publishing what you have written. Many journals. Do not use this term in front of the author (see balanced feedback). Do so gently. But then they would. With most journals. Editors of course will swear that they are never influenced by such things. but use it in the way you select and organize your information – and not to indulge in extravagant ways of expressing yourself. The final paragraph of your letter gives you an opportunity to sell.COVERING LETTER the letter. as a heading. though it does suggest that he or she should go back and do some more work (see process of writing).’ Putting the title at the top of the letter. try humour (‘Our finding is so important and your journal so well-read that they belong to one another’) but it can be a dangerous game to play. If you are submitting to magazines and newspapers for the first time.’ This is dull (most journal titles are dull).

not just in terms of what information they include. either by asking around or. CV Producing CVs involves a difficult balancing act: we need to produce a short account of our life that will be flashy enough to sell us above the heads of dozens. you might wish to re-examine the way you write (see leaf shuffling). The important thing to remember is that CVs are not an all-inclusive description of our entire life and times. It should be constructive. Ask yourself: what are they looking for? You may wish to give something a little more prominence or cut out something else. Don’t buck the accepted conventions: a young doctor of my acquaintance recently had a talented designer friend ‘modernize’ her CV. it will take only a few minutes. If you find that you are regularly having to cut out large chunks of text.THE A Z OF MEDICAL WRITING – Criteria of good writing effective writing). but a tool to get us on the shortlist. Try to see what others are currently producing. • Do some market research. be producing first drafts of roughly the right length. Avoid vague terms (‘prolific author’) and keep to the information (published papers in 23 journals. • Keep updating the information. • Match the CV to the job. Rarely shared and agreed (see Criticism An important part of the writing process. perhaps hundreds. the interview offers started to return (see marketing). she got no interviews. by volunteering to sit on a selection committee yourself. But it takes up a lot of time and you should. • Keep it factual. Regular updates will ensure that you always have on hand the raw material needed to produce high quality CVs quickly. When she returned to the more conventional format. perhaps. Cutting things out This is inevitable. They will encourage you to keep reviewing what you have done – and what you still need to do (see goal setting). Compare the CVs of those who have been shortlisted with those who have not. of rivals – without laying ourselves open to the shameful crime of self-promotion. including seven 32 . but rarely is (see balanced feedback). With word processors there is no excuse for not tailoring each CV for each job. within reason. but also in terms of how they are presented.

CV in the NEJM and two in The Lancet) (see nouns). Be prepared to talk about these in the interview. If not. If they are consistently getting you shortlisted. Choose one or two standard typefaces and avoid polyfontophilia. people may jump to uncharitable conclusions. You need more than ‘walking. If you can’t think of anything. which by definition means that you are improving the product. Keep sensible margins. reading. What is in yours that will get you shortlisted? The one good thing about CVs is that you will have no difficulty in judging quality. cut some out. Keep the type size large (12 point is the convention). Send off a decent copy. but you may need to explain why there is a two-year gap. so that the text is framed within white space. I don’t believe them. The gap of two years when you cooked hamburgers in a bar in Viareggio may have no direct relevance to your subsequent career. eating in restaurants and going to the cinema’. develop some interests – such as playing rugby against or for the All Blacks. Many interviewers say that these are unimportant. perhaps with the odd prize or publication thrown in. or appointments at more prestigious institutions. This means that the section on ‘outside interests’ may be your best chance of putting yourself above the crowd. if you have too many. Make sure that there are no errors of fact: if you describe your stay at St Ann’s Hospital there is bound to be someone there who knows that it is really St Anne’s. however. (If you have had a two-year prison sentence. you may have to brush up on your interview technique. or teaching young offenders how to cook. • Present your CV carefully. • Imagine yourself one of the selectors. then you may need to take expert advice on how to handle this. such as a two-year prison sentence. giving a sense of organization. not the photocopy of the photocopy. and under no circumstances reduce the type size to fit in all the words. then they are good enough. 33 . • Don’t raise unanswered questions. They will be seeing dozens of these. Most CVs contain the same kind of information about careers. If you are not getting the jobs.) • Pay attention to outside interests. appearing as an extra in films.

was clearly very ill’). no less’). They ensure that those putting together the publication are able to cope with the many different and complex sequences of tasks needed. Dashes A useful piece of punctuation.’. away from the word it relates to. It is difficult to convince such people that they are wasting everyone’s time. Deadlines Some treat these as abstract notions. That is untrue: the famous war correspondent was a product of the union of Mr and Mrs Russell. As in (from an earlier draft of this book): ‘Derived from a French word that described the twittering of birds. or for indicating a pause that is slightly more dramatic than that afforded by a colon: ‘He was very smartly dressed – with a collar and tie. Don’t over-use them.THE A Z OF MEDICAL WRITING – Dangling modifiers This is the error made when a phrase is misplaced. put down for the convenience of editors. so don’t push me around’) or a problem in technique (such as failing to allow enough time for others to have their input). The error seems to be more common among those who have had a Latin education. Some people break deadlines all the time. which in turn means that readers are more likely to get into the habit of reading it. This tends to be either a personal statement (‘I am more important than you. so be firm – and have an alternative up your sleeve so that you will be able to fill the pages. writer’s block). In fact publications would cease to exist without deadlines. who appeared smartly dressed – with a collar and tie and a yellow socks – at the clinic. You will rarely have to do this more than once: nothing changes writers’ attitudes to deadlines as quickly as the realization that they won’t be published if they flout them. If you are an editor. 34 . Data junkies Those who are obsessed with accumulating all manner of data for their writing. your duty is clear: if you start to allow people to break deadlines you will be in trouble. including their own (see leaf shuffling. and not of a French word. thereby ensuring that the whole thing becomes not only unreadable but also unfinished. often by the same amount of time on each occasion. It gives editors a good chance of producing a journal-type publication regularly.. the famous war correspondent Russell used the word ‘jargon’ in a different sense .. A pair can act in the same way as a pair of commas (The patient.

linked by a colon.’ The alternative is an ‘indicative’ title. which as its name suggests. indicates what the authors looked at. As a general rule. led by the BMJ. Declarative titles These are titles with a verb in them. they will have seen the main message. Writing is not one task but several – in other words project management. or even grandeur to their utterance. the various stages that you will have to go through.e. making it declarative) will increase dramatically the chances of attracting uncommitted readers. preferably in a diary. 48). Yet many journal editors remain passionately attached to the indicative title. The trick is to lay out in advance. Thus: ‘Acute application of NGF increases the firing rate of aged rat basal forebrain neurons. Decorated municipal gothic Defined by the writer and broadcaster Michael O’Donnell as ‘a prose style that evolves when writers eschew simple words that might express their ideas in a neat and palatable form and use instead language they believe adds dignity. and those who don’t have them imposed by others usually impose them on themselves. They also define the point beyond which writers will stop fiddling (see perfection). Where does this leave the writer? Fortunately there is a clear answer: look in your target journal and follow the style you see there (see evidence-based writing). 35 . who have access to detailed market research on how people read. There is widespread agreement among newspaper and magazine journalists. but doesn’t give away what they found: ‘Expression of glutamate transporters in rat optic nerve oligodendrocytes’. 1997.DEADLINES In fact successful writers realize that deadlines have uses for them also. the US journals are more likely to use the declaratory style while some UK journals. London: BMJ Books. prefer two strings of nouns. as in: “This vehicle is being utilized for highway cleansing purposes” or (using a medical example) “alimentation was maintained” (A Sceptic’s Medical Dictionary. Even if they don’t read the article. scientific worth. Be sensible in your projections (see time management) and allow plenty of time for rewriting (see process of writing). Michael O’Donnell. that putting a verb in a headline (i. Things tend to go wrong when we set deadlines that are too vague. Deadlines provide a target. p.

But take care when writing book reviews and even refereeing papers. If someone makes an allegation about another in court or in parliament. ‘Professor Beychevelle’s study on the benefits of claret is flawed’ is fine. in other words. So the best rule is: if in doubt. gravitas. even worse. for instance.THE A Z OF MEDICAL WRITING – The genre persists. style [1]). the risk of libelling someone should not be high. particularly in papers submitted to committees. The problem with these defences is that they take huge amounts of time to assemble. as in this example: ‘The strategy represents “extra effort” and fresh focus on the part of the main partners to address the key priorities identified. the ‘commie bastard’ is a paid-up member of the party and that his mother never married. but you can’t say that they are incompetent or. the following two seem fairly easy to understand (though be warned. the normal laws of defamation would not apply. It will not lead to a diminution of existing core service provision. However. leave it out. • Privilege. • Truth. or a letter that a secretary opens. It can be spoken (slander) or written (libel). it is ‘protected by privilege’. dishonest. For most readers of this book. You have to be able to prove that. in a publication for instance. As a general rule you can say someone has done bad work (we all do that from time to time). or that the ‘deadly doctor’ has clearly killed large numbers of patients administering 500 mg when the label clearly said 5 mg. Of the available defences. The classic definitions include exposing someone to ‘hatred. Defamation 36 . The act of damaging someone’s reputation with words to such an extent that he or she is awarded damages in court. and you could well face a defamation action. or ‘lowering them in the estimation of right-thinking members of society generally’. The allegation has to be ‘published’ to a third party. repeat the statement later.’ English translation: ‘Our new strategy will not harm existing services’ (see flabby phrases. putting on the posh overcoat. ‘Professor Beychevelle’s study on the benefits of claret is doubtless influenced by the fact that his chair is funded by the Association of Claret Growers’ is not – there is a clear implication that he has changed the data to suit the sponsors. many lawyers have become exceedingly rich discussing their exact meanings and implications). ridicule and contempt’.

otherwise you may be unable to resist the temptation to stop writing and start fiddling. such as coaching. Trying to sort it out yourself will almost certainly make things worse. Dictating machines Some feel that it is cheating to use them. If you have written something that someone claims is libelling him or her. such as embarrassment in open court. It is constantly being updated. This is a type of political writing. not support them. Demotivation When it comes to the writing of scientific papers. All this helps us to get down the all-important first draft.DEFAMATION What happens if you suspect fraud in a paper that you are asked to review? This is a difficult one. and I suspect the best solution is to ring the editor yourself – on a land-line – and put nothing in writing. Should be kept for the professionals. rather than to put a message across. but they are extremely useful. They are fast. All the mechanisms of ‘support’ seem set to criticize writers. balanced feedback and evidence-based writing. act with great caution. Yet there are valuable techniques. Defensive writing Writing that is drafted to avoid trouble. Layout you can Desks Keep them uncluttered. For those who are really interested. this seems to have been elevated to an art form. 1999. London: Butterworths. they encourage us to use a speaking vocabulary rather than a posh writing one (see pub test) and they make it difficult for us to keep track of what we have said so that we plough on rather than fiddle around with what we have just said. Design do. don’t confuse it with effective writing. Contact the editor at once: most publications have libel insurance and they will immediately seek legal advice on your (and now their) behalf. BOOKLIST: legal problems • McNae’s Essential law for journalists. this is the standard book for journalists. 37 .

Within a few years we could all be dictating our first draft straight onto our personal computer. it is good practice. Draft See first draft. and write it for a publication in the same market. in these markets it is usually considered acceptable to write a similar article for a non-competing market (a newspaper for doctors and a journal for nurses. However much you enjoyed speaking at the time. from a freelance’s point of view. it makes sense to tell both editors what you are doing. in fact. We can end up somewhere totally unexpected and quite useless. There are two precautions to take: (1) make sure you are entirely clear what you are saying (see brief setting) and (2) leave plenty of time for rewriting. When it comes to writing for journals. However. then this is considered acceptable. since publication is now used as a key performance indicator (see CV). which no doubt will bring up a whole range of new problems. there will certainly be some tidying up to do. Alas. Journal editors feel aggrieved if they publish an article that has appeared elsewhere. they are not usually highly trained in writing matters. Duplicate publication Magazines and newspapers compete against each other. for instance). many people feel that it is 38 . The development of voice recognition computers may make dictating machines redundant. To avoid inadvertently biting the hand that you are asking to feed you.THE A Z OF MEDICAL WRITING – The disadvantage is that we can get carried away with the sound of our own voice and our own brilliance. If you later want to revisit the topic. Also. Thus we cannot exclude them from being considered harmless. the matter gets rather more complicated. they are equally not inconducive to incomprehension. And we need someone to transcribe what we have done. and therefore consider it quite wrong for an author to offer the same article to more than one publication at a time. but in a substantially different way. Double negatives These are not uncommon. Doctors They are highly trained in medical matters.

micro-editing. Editor This is the person at the centre of a publication. It seems reasonable that someone who has written an interesting article in one language should be allowed to communicate to those who speak (only) another. macroediting. • gathering and presenting material. and who therefore defines the publication’s ‘soul’. nor should you revamp a published original scientific article and send it to another journal. If in any doubt. There is a clear solution for writers: under no circumstances should you send the same article to more than one editor at a time. editor. copy-editor. quietly) what they have written. speak to the editor. It is a key position. Failure to do so is scientific fraud.DUPLICATE PUBLICATION cheating to get two sets of points for one piece of work (see also salami publication). 39 . which is whether authors can write the same – or a similar – scientific article in two different languages. unless we happen to be doing the writing at the time (see effective writing). subeditor. thereby putting everything in the open and enabling the editor to make a decision in full view of the facts. editing of. There is a trickier issue. the author should make it absolutely clear what is being done: he or she should refer to the previous paper. Ear A useful tool for judging whether a piece of writing works. and editors find themselves co-ordinating a web of activities: • ensuring that the publication has enough funds to keep publishing. Editing See books. Easy reading Something we all value. technical editor. who is responsible for what is and what is not published. However. This is why many people find it useful to read aloud (preferably to themselves.

but there is a clear difference between the two roles. which is to take a submitted article. Unless you reject contributions. A large part of the job consists of deciding what goes in and where. consider the following advice. (b) how you will get there. • Define your readership precisely – and serve it obsessively. • Don’t be afraid to turn things down. or try to reconcile irreconcilable groups of potential readers. editorial integrity). because the verb ‘to edit’ has another meaning. Do not accept responsibility without power. and (c) how you will know when you do. • Have a clear view of what you are trying to do. Find out where the limits of your power will be – to whom will you report and under what circumstances can you be fired? This is particularly important if you are being appointed by a professional (as opposed to a commercial) organization (see editorial freedom. or try to please those who aren’t readers (see false feedback loop). and be sure to let them know when you achieve it. then you could be in trouble. Find out what they want from you. • Maintain clear lines of communication with your employers. Publications work if they meet the needs of a definable group of people – the readership. One of the first tasks of the editor is to decide in his or her mind what this group is – and what distinguishes them from other groups. warn them. the same person will be editor and subeditor. you are working as a clerical assistant. particularly those of proprietors. • making sure that readers receive their copies. you need to have a clear idea of (a) where your publication is going. To do this. the task is to keep them faithful. Being an editor of (as opposed to for) an ‘ongoing publication’ is a time-consuming task. • Don’t start unless you are absolutely clear what your role is to be. and improve it. Make sure all those involved (from owners to readers to contributors) know all this (see mission). authors and the ‘general good’. readers. Before you accept the honour. subeditor or technical editor. particularly on small publications or newsletters. There can be confusion here. and you must make these decisions rationally. and so on. If you anticipate trouble. Once these people are defined.THE A Z OF MEDICAL WRITING – • setting deadlines and ensuring that they are met. Sometimes. They have to juggle a range of competing interests. And remember to massage their egos (see managing upwards). not an editor. If you fail to define your readers. This is the task done by a copy-editor. That doesn’t 40 .

praise. dealing successfully with The writer–editor relationship is like the patient–doctor relationship: you are highly dependent on someone else’s goodwill. Good contributors will solve problems. expose you to challenging ideas and force you to learn new skills. but they do have the right to assume that the articles are honestly written. Keep everything in perspective.EDITOR mean that you can ignore basic principles of courtesy. These could be vulgar financial ones – or something less tangible such as job satisfaction. People may treat you as a very important person. • Give editors what they want. • Research your market thoroughly. not cause them. not editing a publication. you will be made welcome. It may even allow you to do a little bit of good in the world. Readers nowadays are unlikely to expect that your publication consists solely of the Truth. • Keep trust with your readers. Look also for any Instructions to Authors. the writers could and should have been able to work this out for themselves. They find this tiresome because. involve you in some challenging decisions. Watch how quickly the invitations dry up when you leave your post. like thanking people for what they have done (see commissioning). put you in touch with exciting developments. but don’t count on it. If approached with care and proper planning (see time management). • Form a team and motivate its members. and follow them to the letter. Make sure that you do not become a heartsink writer by following these guidelines. Editor. If you can do this. in most instances. Seek out people who will contribute their energies and diverse talents. and the type of writing in each (see evidence-based writing). One of the most common reasons why editors reject articles is that they are not right for their publication. the role of editor will help you to forge new friendships. • Don’t have delusions of grandeur. then ring up the publication. If you still have any questions or doubts. and that they have been chosen on merit and not because money or some other favours have secretly changed hands. but that’s mainly so that you can be nice to them. Look at the various sections in the publication. and a feeling of teamwork. The key is motivation – enthusing them with your view of the future and helping them to share in the rewards. Unless you have contributions from others. In particular they will solve the editor’s need to fill blank pages with material that will interest their readers. 41 . you are writing a pamphlet.

• Don’t get it wrong. If you are not known at the publication. it can be a dangerous model to follow. not only from members of the board but from their colleagues and friends. when those given this honour have so many other things to do that they have little time left over for interfering. If you have been published already. This is useful marketing: being able to drop the names of all these dignitaries adds prestige. Don’t betray that trust by submitting articles that have been sloppily researched (see checking facts). Be careful about arguing: what you are really saying is that in your opinion the editor is unfit to edit. Arguing that you should have been paid £120 not £110 will not help in the pursuit of this task. Write a covering letter. Unfortunately. 42 . Editorial boards Many journals have long lists of eminent people from all over the world who make up their editorial board. It also helps to attract contributions. and this can fool writers into believing that their work is better than it is. It’s fine at this level. and then getting published again. it will probably leave a rather sour taste in the mouth of a formerly supportive (and possibly less well paid) editor. Trust the editor’s judgement: after all making decisions is what editors are paid to do. • Don’t quibble about pay. Editors have to take a leap of faith when deciding whether to publish. Writing is a personal and lonely activity.THE A Z OF MEDICAL WRITING – • Ask yourself why the editor should trust you. enclose a few cuttings. This is unlikely to make him or her change their mind (see rejection). Don’t expect them to be read. • Respect the editor’s decision. They also threaten to divert the publication from serving the needs of readers to serving the needs of the board members. particularly newsletters. but melt away when it comes to implementing them. Money can be very destructive in a relationship. But for smaller publications. so take care. but your chances of being published in the Little Snodgrass Gazette won’t be harmed by a byline or two in The Times or even the British Medical Journal. Some organizations favour them at this level because they believe that they spread the load (and make sure no one gets too important). The main thing is getting published. make sure that you establish your identity in a way that can be easily checked. these committees (for that is what they are) tend to increase the editor’s workload as they dream up more and more ideas.

Editorial integrity Clearly editors are unable to act completely freely. They have responsibilities to readers to publish material that is accurate and true. • What will be the benefits of an editorial board? Committees can be expensive in time and money. But not always. and have a right to expect that it does not actively oppose their interests.EDITORIAL BOARDS For those still considering an editorial board. or adding prestige and credibility. • Does the agenda reflect this role? Do you want the board to give ideas. the owners have the right to change editors if they feel he or she has taken the wrong decisions. and charge off in a direction that is as dangerous as it is unexpected. Unless editors are also owner-publishers. An editor must have the right to edit. producing written reports to back up your proposals and undertaking personal lobbying on the more important issues. Take time to plan. Make it clear what power they will have and what duties they will perform. • What’s in it for them? Altruism is a rare commodity. Editing therefore becomes the 43 . Go ahead only if you think these disadvantages will be outweighed by the advantages – such as widening the network of supporters. have a clear view of what the role of the committee should be. they are inevitably responsible to a more powerful individual or organization. A more useful concept is that of editorial integrity. They can also be unpredictable and irrational. providing political back-up. Finally. They have legal constraints (though it is part of their role to push against these). in other words have the last word on what is or is not published. or do you want them to ‘review’ your last issue (which will probably add little to anything other than your own discomfort)? • Have you prepared thoroughly? Meetings such as this can suddenly have a collective rush of blood to the head. so people who sit on such committees tend to want something in return. • Is their task tightly defined? If you decide to go ahead. Editorial freedom Not a useful concept. here are some sensible questions. Sometimes you will get away with giving them a bland meeting and an exciting meal (better than the other way round). as far as is reasonably possible. The solution is two-fold. they have a responsibility towards the owners (or owner) who fund the publication. At the same time.

For instance. which is not taught in medical schools. so that the whole weight of the publication can go behind it. displayed in a prominent position. Editorial material The generic term for written material in a publication. Consider a report successful when your 44 Effective writing . I favour a more practical definition: effective writing achieves the purpose we set it. Editorials A piece of writing. the opinion clearly belongs to those who wrote and signed them. They are also called leading articles or leaders. which themselves seem to be moving towards state-of-the-subject reviews (see review articles). and one of the main tasks is to ensure that he or she can carry out the actions needed to fulfil their vision. Many newspapers. magazines and journals have these as unsigned articles. In these. and the way to measure it is to set out in advance what you want to do. And it’s elegant’ (see style). It sort of flows.THE A Z OF MEDICAL WRITING – art of the possible. you can consider an article a ‘good’ one when it is accepted for publication in your target journal (waiting for praise is likely to disappoint). that expresses a strong view on a matter of importance to a publication’s readers. This distinguishes it from advertising. Defining this is one of the most important issues in this book. analyse carefully the type of product that is expected. It is not an art form but a tool. Effective writing does not set out to be obscure and misunderstood (see political writing). If you are invited to write an editorial. Writing them is considered to be one of the more elevated tasks and those writing them are allowed to be unusually pompous. nor is it written to satisfy some urge within the writer (see great writers). Look through several in the target publication and identify in particular the structure and the language. Unfortunately. Mixing the two produces the unsatisfactory and confusing mess known as advertorial. many people are vague about what they consider to be good writing. This then becomes the standard you can measure it against. Some medical journals have moved away from this tradition of anonymous comment towards signed editorials. and define it in subjective terms: ‘I know it when I see it. This involves the key skill of managing upwards.

we reproduced it on paper and provided each reader with a copy. The principle is that writing is your servant. dramatic changes to the way we read and write. A leaflet appealing for blood donors can be considered a success when the target number of donors appears. particularly to the world of scientific publishing. or (under different circumstances) does not come back for more information. you can also define in advance how to measure it. for all kinds or reasons and with no real evidence. and not surprisingly many of them come back wanting to write about them.EFFECTIVE WRITING preferred recommendations get accepted. that your writing is poor (see PIANO). Electives Medical students find these exciting things to do. This means more than finding an exotic destination (see travel writing). Unfortunately this means that it’s hard to find a market for them. and don’t believe those who tell you otherwise. Now the situation has been turned on its head. if we wanted to distribute what we had written. continue to read. they must contain an original message. With the global network of interlinking computers (see World Wide Web). so that any paper considered of adequate quality by the reviewers can now be published. If you define in advance what you want your writing to do. Electronic publishing Written communications are in the middle of a revolution which is making. on the World Wide Web. This has brought some major opportunities. Sadly there is no alternative to this. 45 . To stand a chance of being published. In the old days (though not that long ago – the pace of change is so fast). and the process of peer review can take place publicly. producing more copies for more people requires little extra cost. understand and act upon. Be satisfied with a letter if the recipient comes back for more information. Failure to do this can lead to confusion and depression as you start to believe those who tell you. not your master. and will continue to make. Effort What is needed to turn the first draft into something that the reader will look at. Papers can now be published much faster. The balance between supply and demand will change. even as the paper is being formed.

There will be migration towards the higher status journals. because it allows those working in the media to prepare in advance and come up with wellresearched reports as soon as the event has taken place. I suspect that this is because people generally write to a named person. and some e-mails will start to be as boring as other types of writing. but giving information and summaries about those they have published on their Web sites. Thus they will put words in CAPITAL LETTERS. what will happen if the power goes off? E-mails. How will publishers make money from electronic publishing? Will there be a role for traditional publishers. enjoy. which means that they have a clear definition of the target audience.THE A Z OF MEDICAL WRITING – The implications are great. writing of One of the curious things about e-mails is that. Embargo A notice put on a press release requesting that publication of the news is delayed until a certain date and time. This may work in small 46 . Some public relations advisers overdo it. There are still many fundamental questions still left unanswered. and those lower down the scale will have difficulty finding original papers. Even the prestigious journals may start to move towards a secondary role – not publishing original papers. E-mails are sent immediately. and back towards their original role of informing readers about significant new developments. This system is useful when the press release is linked to an event. putting on artificial embargoes: these are likely to be broken. No doubt this will change. many of them still retain a freshness that has long since disappeared from other types of writing (see putting on the posh overcoat). so there is no time for the false feedback loop to come into effect. even in the workplace. or will we all start to suffer from information overload? Most important of all. or will the task of publishing original papers be taken over by other organizations? How will we find our way around. Emphasis Many people embark on a false and gimmicky quest to give emphasis. or in bold type or in italics. Meanwhile. Journals will move away from their modern role of validating science and defining hierarchies. like the budget speech or the Queen’s list of honours.

put it at the end of the sentence. We read in certain ways. place it at the beginning or end of your writing (see first sentence. which gives us key positions to exploit. Those who argue otherwise are either fooling themselves (and boring their audiences). Don’t be afraid to enlist the help of someone who is familiar with the particular brand of English you choose.EMPHASIS doses: it can be effective to use italics to emphasize one word. but several. The best solution is to order your words in such a way that the natural cadences will emphasize the words and phrases you wish to emphasize. paragraph or piece of writing. 47 . but if you use it for more than a word or two it becomes difficult to read. who clearly traumatized them. Use the version that is most appropriate to your target audience (see evidence-based writing). Enthusiasm Be wary of those who wax lyrical about how much they enjoy writing. Behind many writers lurks a figure from their youth. Evidence-based writing My concept of ‘evidence-based writing’ is simple. most rational people hate it. in particular the start and the end of a sentence. final sentence). but ignore what goes in them. according to a number of studies (see research on writing). or lying. Putting something into a box is also a bad solution: the evidence suggests that people tend to notice boxes. If you want to emphasize a single word. as here. If you want to emphasize a sentence. If you have defined carefully your target audience. Endings English See final sentence. English is not one language. all of which are developing in different ways. English teachers They have a lot to answer for. destroying their confidence and instilling into them false rules about the use of ‘and’ and split infinitives. It is important for those traumatized in this way to realize that they have moved on and should no longer be writing to please their teachers (see audience. false feedback loop).

much more than an abstract tacked on at the last minute because that’s the way it’s done. but a great opportunity to do some effective writing. Instead of arguing endlessly whether to use jargon. look at the evidence of what your target audience prefers. Exclamation marks Most people insist that they should be used only to signal an exclamation and not to signal a weak joke. or pompous initial capitals. or split infinitives.THE A Z OF MEDICAL WRITING – then the type of writing you need is the type of writing that has worked for that audience in the past. But don’t overdo it. on the other hand. 48 Executive summary . follow the style of that journal. or the passive voice. and written in a formal ‘professional’ language. They follow certain conventions – they are lengthy. full of data. It should be shorter (rarely more than a single page). I think the time has come to change positions: they can be very useful to signal a weak joke. follow the style of that newspaper. if writing a report for a committee. If writing for a journal. The goal of the executive summary. but as a powerful tool of communication (see effective writing). This is probably because much of their writing has been dominated by the unnatural act of sitting examinations – taking a couple of hours to regurgitate previously memorized information. then follow the style of reports that have been previously accepted. written in a more accessible language (see readability scores). This puts writing on a rational basis. Examinations Many otherwise intelligent professionals still approach writing as if they have to ‘get it right’ first time. and much. After many years repeating this advice (but ignoring it in my own writing!). if writing for a newspaper. And so on. This approach will save hours of argument and stress (see negotiating changes). is to sell the recommendations to the busy decision-makers. A shortened version of a long and boring report. We all need to move on: treat writing not as a measure of goodness or cleverness or niceness. The purpose of writing reports is to make recommendations and provide evidence in favour of implementing them. and use the more reader-friendly inverted triangle structure.

this can become an extremely demotivating stage. but because they are all working to their own agendas. so that it meets their purposes rather than those of the target audience. 49 . Contributors and authors have a right to be dealt with promptly and openly. who should respect an editor’s right to decide which of several acceptable submissions should be published (see rejection). This is not because these people are out to get us. I describe this as the ‘false feedback loop’: it is the pressure from those commenting on a piece of writing to have it changed. policy documents written for more senior bureaucrats rather than the more junior ones who will have to carry out the plans.EXECUTIVE SUMMARY This reiterates one of the recurrent themes of this book: if you want to write successfully for two different audiences you need two different pieces of writing. Facts. scientific articles written by French doctors for other French professors rather than American editors. fear of process of writing). Editors have a right to be treated fairly by contributors and authors. checking Failure. This explains why the health services are full of unreadable publications – leaflets written by doctors for other doctors rather than patients. More importantly. changes made now may destroy much of the good work already done. False feedback loop One of the most dangerous parts of writing comes when we give what we have written to others for informal advice or formal approval. Unless handled carefully (see balanced feedback). See checking of facts A major reason why people don’t write (see Fairness Readers have a right to expect that an article has been selected for publication because the editor has decided that publication is in the audience’s interest.

each corresponding with a paragraph. but the first (and possibly only) opportunity to involve the uncommitted.’ After a few paragraphs the writer can raise a question and set up a dynamic: ‘So is a diet of carrot juice and boiled rice the best preparation for a marathon run in Antarctica?’. Until now. it also reduces hair loss. If you are asked to write one. and assess all feedback accordingly. 50 . Give in graciously over proposed changes that will not affect the chances of the document being read and acted upon. which is the reason for the most important difference – the structure. A news story will start with a strong message. resist tactfully – and with evidence – those that are likely to turn your audience away (see negotiating changes). Feature articles tend to allow more comment. There are three elements. and then add supporting information in decreasing order of importance (see inverted triangle). study the publication before you start (see evidence-based writing). The feature article. Explain each step in the first sentence before going on in the rest of the paragraph to elaborate.’ Features are a broad category. • Remember that you are the reader’s advocate. Feature article Writing for magazines and newspapers has traditionally been divided into news stories and feature articles. • Conclusion. A common way is to start with a personal story: ‘John Smith has always been worried about his appetite. We need to plan a small number of steps. The opening is not a gentle statement of what is to come. has to have a more sophisticated structure designed to guide the reluctant reader through to the end. • Development.THE A Z OF MEDICAL WRITING – But the false feedback loop can be controlled: • Make sure that whoever is reading your manuscript knows the audience you are addressing. • Introduction. This should at least encourage them to make their suggestions with the end-users in mind (see evidence-based writing). Make sure you understand precisely what the editor wants (see commissioning). At the end of the article the writer will generally leave the reader with a clear conclusion (or message). This is how we get from the introduction to the conclusion: it is the difficult bit. illustrate or explain (see yellow marker test). being longer. that will develop our argument. They also tend to be longer. such as: ‘The carrot and rice diet is not only good for ice-cold marathons.

. First sentence The purpose of this is generally to attract passing trade (see inverted triangle). writer’s block). ‘In this study we found . the message should be shamelessly sold in the first sentence (see inverted triangle structure).FEATURE ARTICLE Follow the usual principles for the process of writing. Many great works of literature have been written in the first person. However. press releases and executive summaries. on the other hand. see journalism booklist.’. false feedback loop. Many people feel that they have to end on a high note. For these types of writing. for memos. See illustrations. ‘he’. the final sentence can be the dullest. Look in your target journal (see evidence-based writing). when the jumble of ideas in our head has to be put down in some sort of order. ‘she’. the first person. particularly in the methods. editorials and scientific papers. First person This is the grammatical term for using ‘I’ and ‘we’ rather than ‘you’. as in.. and in some cases encourage. topic sentences). They are right when it comes to feature articles. Feedback Figures See balanced feedback. We often find it difficult to get through this stage. and have all kinds of strategies for putting it off (see free writing. letters. First draft The defining moment for a piece of writing. Scientific papers are an exception to this rule (see IMRAD. For more information. Final sentence Finishing See getting finished. In fact journals are beginning to accept. those writing scientific papers. 51 . news stories. feel that it is vulgar and detracts from science as an objective pursuit (see voice). review articles. or (if one is royal) ‘one’.

Freelance A writer who is not on the staff of a publication. Fraud See scientific fraud. You are unlikely to make one of these out of your writing. You will find it easy to increase the impact of your first sentence by turning it around. You might consider this an unacceptable price to pay (see careers in writing).. to read a whole sentence. Journalists tend to use the term as a compliment. based on the assumption that. ‘a redundancy situation’ that we use all the time. Some doctors like to use this word as an insult. as in: ‘The effect of red wine on health has been assimilated in many studies. ‘at this moment in time’.’. on the grounds that someone can’t be that bad if they 52 . such as ‘general public’.THE A Z OF MEDICAL WRITING – First six words test This is a simple test. That is why it is important to leave time for rewriting.’ Fish and chip wrappers One of the great consolations for those who dabble in the imperfect craft of writing (see law of late literals) is the thought that what is read and digested today will tomorrow be wrapping something that is eaten and digested tomorrow. and asking the question: ‘Could I persuade more people to start reading if I were to use different words?’. but who is paid for contributions. unless you are Jeffrey Archer. Fog scores Fortune See readability scores. we have to start by reading the first few words. Weak openings would include: ‘Considerable debate surrounds the effect of ...’ or ‘Although many studies have examined aspects . on the grounds that anyone not drawing regular income must be treated with suspicion. a whole paragraph or (heavens above!) a whole piece of writing. This test involves reading out loud the first six. Flabby phrases There are countless words or phrases..

This should help you make up your mind as to whether to trust them with your opinions. and whether the article has been commissioned. There are two caveats. Resist the pull to look back at what you have just written and start fiddling with it. My experience encouraging people to do 10 minutes free writing on a training course is that they find it threatening and difficult for the first two minutes. But they usually find that their message has come across clearly. But. so in 20 minutes you will have drafted 600 or so words.’. or not. Second. now you have coaxed it out of your head and onto a screen or piece of paper. Free writing A splendid technique that allows you to write creatively. you will almost certainly need to do further work on your draft. otherwise it is a process of free thinking (see branching). without any distractions such as reference books or photocopied articles or even the original data. you have something to work with. If you find this impossible. just sketch out the paragraph headings until the end. When you have finished one sentence. The trick is to get started so. ask which journal they are writing for. People are fairly suspicious of what they have written in this way. Free writing works well if it is preceded by planning. If you haven’t finished when your allotted time is up. if you write straight onto a computer. That said. cover up your writing so that you can not look back. Go into a room. move on at once to writing the next. Often they start to write about things that they did not realize they knew about: in other words they started to unleash their creativity. and start to write. You may find it particularly difficult to put down the first sentence. If you happen to be approached by one. You should be developing your ideas.FREELANCE have got the courage to leave the boring world of office grind and live entirely on their ability to write. then become completely absorbed. keep going. and that the structure (as identified by the yellow marker test) is unusually well-paced and clear. 53 . in which case you should put down any old sentence. and not playing with the punctuation. Stop at a set time (use a kitchen timer if you have one).. such as. there is no bar to anyone ringing up and saying that they are a freelance journalist.. You should be able to write about 30 words a minute in this way. ‘I am sitting here trying to write about . once started. turn off the screen.

p. is to set a deadline. • any company sponsorship is clearly declared (see conflict of interest). Quite. 1972. This use seems to be declining and many publications now use the style of ‘Mr’ or ‘eg’ (rather than Mr. and 54 . London: Heinemann. and that is when you are using abbreviations. From an ethical point of view. and actually finishing. (Newsman’s English. provided that: • the listed first author has had a major intellectual involvement with the study (see authorship). Fun If you are not enjoying yourself. the eminent editor of the Sunday Times in the 1960s and 1970s. Getting started This is much harder than getting finished. There is another use for the full stop. work towards putting words down on paper where you have a chance of controlling and developing them (see process of writing. because of the increasing pressure among individuals and organizations to have articles published in the top journals. As a general rule. Harold Evans.). Be guided by your target publication (see evidence-based writing). In the world of scientific journals this is a contentious area.g. The best way of getting out of this loop. or e. Harold Evans. how do you expect your readers to? Getting finished Perfectionists will keep fiddling with what they have written for ever. 20). writer’s block). there doesn’t seem to be any problem with this practice. Ghost author This term is used to describe a professional writer who has done most of the work on a piece of writing and who may or may not be given any credit. wrote in his book ‘The full stop is a great help to sanity’.THE A Z OF MEDICAL WRITING – Full stops Also called full points.

for children or foreigners or journalists. buy a book – not one of those thick tomes with acres of small print on the finer points. but who has not had a major intellectual involvement. Gobbledegook is just old-fashioned rubbish.’ The term ‘gobbledegook’ is usually considered to have the same meaning as jargon. when one person says or writes something in a particular language. Yet most of us think that we are pretty bad at it. elaborate or alter the circumstances in which they occur. swooping on fairly unimportant deviations (like split infinitives) and using them to demotivate the writer and devalue the writing. This is not considered fair (see authorship.GHOST AUTHOR • the named authors realize that they have accepted responsibility for the paper (see gift authors). If you are really keen. Good writing Grammar See effective writing. Alternatively. These are 55 . These people scan the writing of others like hawks. However. Gift author Someone who has his or her name at the top of an article. but a short book. is often used to describe language that is overblown. and some of our colleagues waste no time in trying to convince us of this. or identify the parts of speech. pompous and virtually meaningless. ghost author). reflexively supplying meaning to actions and objects as those meanings maintain. Gobbledegook This term. originally from the US and probably inspired by the language of turkeys. or decline. We may not be able to parse. Most of us are pretty good at it. these contexts of interpretation are themselves ongoing accomplishments. used inappropriately. I think a useful distinction can be made. that gives you the main rules. Fortunately there are several strategies you can adopt to produce well-grammared sentences (a bad example of verbing – see verbs). Grammar is simply the set of rules needed to ensure that. which is that jargon is essentially technical language. but we do manage to use the rules to put our messages across. as in: ‘At the same time. use the grammar checker on your computer. others sharing that language will understand.

you should make sure you get help. I recommend buying a departmental copy that can be used to settle matters in dispute. Getting help. 1986. BOOKLIST: grammar and usage • English for journalists (2nd edition). with the author whizzing through the basic rules of grammar in 12 pages. • Fowler’s modern English usage (3rd edition). Useful to dip into. For reasons that I find it hard to identify (it may simply be a matter of typeface). by Wynford Hicks. isn’t cheating: it’s sensible project management. but don’t try reading it in one go. it seems less stuffy. by Sir Ernest Gowers. and ‘making it grammatical’. 56 . and you don’t even have to have studied grammar at school to work out what you need to put it right. so these are extremely important pieces of writing. • The good English guide. edited by RW Burchfield. 1998. Grant applications Careers depend on persuading organizations with funds to give support. revised by Sidney Greenbaum and Janet Whitcut.THE A Z OF MEDICAL WRITING – getting much better than they used to be. It is aimed at journalists but useful to a much wider audience. Finally. Most books on grammar consist of long and complicated lists and are completely indigestible. A highly readable reference work showing the idiosyncrasies of the English language. if you are part of that group of people who went to school when it was fashionable not to teach grammar. • The complete plain words (3rd edition). London: HMSO. and grant applications should be approached in the same way as any other pieces of writing (see process of writing). 1993. Find someone who will love going through what you have written. There is no magic formula. This book is blessedly short. Oxford: Oxford University Press. this book gives plenty of good advice on writing clear English. London: Macmillan. An early voyage by a subsequently famous travel writer. Similar to Fowler’s. London: Penguin (revised) 1999. by Bill Bryson. 1996. London: Routledge. Originally written to encourage civil servants to write in plain English. from whatever source. by Godfrey Howard. • Troublesome words. I have six particular points to make. The cover proclaims that this is ‘the acknowledged authority on English usage’.

in particular guidelines for those submitting proposals. Many organizations will give you feedback. or (particularly if patient groups are involved) have had a demonstrable clinical effect. in which case how do you find out the right one? Did it fail to inspire the panel. • Work out carefully the message you would like to give if your research is successful. and make sure that your message is clearly given when you write your application. Throw a party. Ask for. and read carefully. Work backwards: what headlines would you hope your research to attract (provided all goes well)? Use these thoughts to inform your message. Target these organizations: a fundamental law of selling states that it is easier to make a sale from someone who has already bought (and seen the benefits of) a similar product. and your colleagues should also be able to help you. • Invest time in researching the market. Put aside time so that you can do this properly (see time management). they do get points for funding work that can be seen to have moved forward our knowledge of science. and invite all those whom you wish to impress. Many directories will give you information. in which case can you remedy it? Was it sent to the wrong organization. One of the best ways is to identify the key papers in your field (defined as tightly as possible) and try to find out where the funding came from. so don’t treat it as something to be bolted on to your life at the end of the working day. Study it carefully. Was the work flawed scientifically. This is as important as researching the topic you wish to investigate. This is extremely important. in which case was it because you failed to make clear the amazing implications – or was it a run-of-the-mill idea that will not advance anything very much and therefore will prove difficult to fund? • Make the most of a successful application. Try to find out what they have given money to. Don’t be bashful: everyone loves a success (well. learn from it. You cannot research too thoroughly what the organization wants. any literature that they produce. and if possible get hold of those proposals in order to analyse the structure and style. Grant-giving organizations get no points for giving out money.GRANT APPLICATIONS • Find the right organization to approach. • If your application is unsuccessful. up to a point) and you should unashamedly use yours to advance your own interests. • Make time for your submission. 57 .

Gut reaction The main way in which editors choose articles for their journal – a feeling that it is somehow ‘more right’ for their readers than the alternatives. This book deals with writing as a craft not an art. This is what they get paid for. so ‘greatness’ is beyond its scope. hide your ink preference by using a word processor. but hardly reader-friendly (see putting on the posh overcoat). Good enough will do (see effective writing). 58 . This is not evidence based.THE A Z OF MEDICAL WRITING – Gravitas The ability to make the commonplace sound original and impressive. Although the system is not scientific. it is as good as any other system of selection – perhaps better. Hanging participles Hard copy See dangling modifiers. Those of us of a certain age remain sentimentally attached to it. if you write a letter to an editor. Titles (as appearing on the top of scientific papers) are labels that identify what the writing covers. but (with the exception of declarative titles) they do not give away. or try to sell. Green ink brigade There is a prejudice among many editors that those who write in green ink are mad. Until someone does the definitive study. Good for glittering careers. Headlines There is a useful distinction to make between titles and headlines. however. Text that appears on paper rather than being electronically stored and presented. Great writers These are born and not made. the message. They are an invitation to those who are interested to read further.

then count it as a victory for you and your subeditor. the title you choose is unlikely to make it through to publication. If they say ‘yes’. They also have to write to very tight design specifications – such as (in the first story above) four lines of no more than 10 characters each. and (2) something that is free or giving praise. Holiday writing Homophones See travel writing. But they are clearly stated. and there’s a good case for arguing that this is better than no credible message at all (see Pravda effect). 59 . • principal and principle: (1) main (person). Yet it will be on the headline that your peers will focus their critical powers (see false feedback loop). such as: • born and borne: (1) arriving in this world. These design considerations mean that. Avoid such behaviour (see dealing with editors).HEADLINES Headlines play a more aggressive role: their task is to attract more than just committed readers and therefore their function is to sell the message so that casual readers will want to find out more. The job of subeditors on newspapers and magazines is to write these headlines. • complementary and complimentary: (1) something that adds. never accept no for an answer. but advertising. • discreet and discrete: (1) not likely to gossip. ‘Too much salt kills baby fed cheap diet’ and ‘SHAME OF SMOKER MUMS’ may appear garish to those brought up on science journals. and (2) carried. • stationary and stationery: (1) at a standstill. there are many confusing pairs. Don’t be put off: ask them if they read the story underneath. They are not summary. and (2) envelopes and writing paper. and (2) a rule. and the messages may not be to everyone’s taste. homophones are those that sound the same. and on copy where the message is not always clear. keep arguing and generally behave like the worst kind of patient. They often have to do this to tight deadlines. when you submit an article. and (2) each separate piece. Heartsink writer Some writers always know better than their editors. When it comes to words.

Now the computers seem to be in control: there seems to be little we can do to change this. • layout. many of the words become split over two lines. Unfortunately. put them in to help the reader group words correctly. style guide. Currently it is fashionable to leave them out. while the notion of building wings was ingenious and the construction of them skilful.THE A Z OF MEDICAL WRITING – House style See Instructions to Authors. and when he flew near to the sun the wax melted and he fell back to earth. or to avoid ambiguity (last-minute changes or last minute changes?). typesetters could take time and care to avoid this by subtle manipulation of letters and spaces. Which sentence brings us to another question: should we be ending sentences with prepositions? Who cares (see English teachers)? Humiliation Some see this as an essential part of commenting on what another person has written (see balanced feedback. the theory was based on a major miscalculation: his wings were made of feathers and wax. Try to ignore it. This leads to phrases such as ‘a primary health care led NHS’ that are virtually impossible to understand at first reading. When narrow columns are being used. Icarus was the one who soared nearer and nearer to the sun. when type was set by hand. Hyphens These give rise to two main problems: • whether to put them in at all. This can turn the right-hand margin into a succession of small horizontal lines. and therefore hyphenated. However Some people get really worked up as to whether ‘however’ is allowed to go at the front of a sentence or not. In the old days. Others feel it’s not worth wasting time on. Icarus fallacy In Greek mythology. As a general guide. politics of writing). 60 .

when appropriate. It is almost always possible to work out how ‘good’ a paper will be (i. Thus an article which started out fit for the Northumberland Digest of Dull Medicine will eventually. When writing for magazines and newspapers. The exception is if you have taken photographs. Illustrations When writing for scientific papers. painstaking and painful) advice from colleagues and professors. is that anything that can be lost will be lost. See also case notes. which journal is likely to publish it) before you start to write the first draft (see brief setting). If the basics are not there before you write (i. particularly valuable ones. the idea is not original enough. As with travel writing. once launched. with ‘high quality’ (i. make sure that you have their written consent. Keep the original and send a copy. or the numbers too small) it is unlikely to change during the process of writing. can soar higher and higher towards excellence. 61 .e.ICARUS FALLACY This triumph of optimism over advance planning seems appropriate to describe the assumption that a scientific paper. Ideas The problem is usually having too many of them. Illness Many people find it helpful to write about the illness of themselves or of a loved one. Take guidance from the Instructions to Authors and from the Vancouver group guidelines. A useful principle when submitting illustrations. the supply greatly exceeds the demand. and regarding publication as an unlikely bonus. Your chances of getting an article of this kind published increase considerably if you can draw out of the particular case some general message.e. for instance on an expedition to the North Pole. rather than not having any at all (see rumination).e. If you are using pictures of patients. you will not normally be expected to provide photographs and illustrations: the editorial staff will organize these. But don’t let this deter you: on these occasions you should be writing for yourself. have the editors of the New England Journal and The Lancet fighting over it. you will be expected to provide these. This of course is just not true. that cannot be replicated.

But despite the elegance of the idea. This is now a huge enterprise. Most of those involved with science publishing agree that the system favours US journals. impact factors have encouraged them to choose publications on the basis of the points they are likely to get rather than because of the audience they would like to reach. and the figure is rising’).. impact factors have had a baleful influence on medical writing. (2) the Alarmist (‘Hundreds of left-handed people commit suicide each year claiming that they cannot get their scientific papers published. and that individual editors from all over the world directly and indirectly encourage authors to cite from their own journal. But it doesn’t seem a sensible use of anybody’s time and money. is not the first one but the last.THE A Z OF MEDICAL WRITING – Impact factor Eugene Garfield hit on the idea of measuring a journal’s worth by working out how often the papers it publishes are cited by other journals.’). Each section answers a simple question. Despite what many people think. and those with a lower index start to struggle. the first sentence is generally dull and can be divided into three types: (1) the Seminar Approach (‘Left-handedness is a condition affecting 10% of the population . which typically describes what the authors did: ‘In this study we conducted a postal survey of 2 million doctors to see if there was a link between authorship and left-handedness. rationalizing it by saying that at least they will get a high quality review. the index is suspect because it modifies the human behaviour it tries to measure.’ 62 . • Introduction – or why did we start? The typical introduction consists of two or three paragraphs.. therefore. and the idea was to help writers by using a simple four-part structure. IMRAD structure The model was originally proposed by the British scientist Bradford Hill. and (3) Much Discussion Recently (‘There has been much discussion recently about the impact of being-left-handed on the task of writing scientific papers’). As a measure of quality. undertaken by the Institute for Scientific Information in its annual Journal Citation Reports. It encourages them – and their co-authors – to hold out for a high impact journal. of course. even though any rational view would tell them that the work in hand is simply not appropriate (see Icarus fallacy). Some departments now send their article routinely to the higher impact journals. As for writers. The whole thing becomes self-fulfilling as those with high scores attract the best pieces. The most important sentence in the Introduction.

should you use this structure for anything other than original scientific papers. and perhaps some papers for other professionals who are somehow expecting that you write this way. 63 . • Results – or what did you find? This section tends to consist of six to seven paragraphs. the last two or three generations of scientists have become used to it. because it follows the same structure).’ It then moves on to put these conclusions in context. the future direction of work. The main message is at the end (if at all) which is not a logical place to put it. however. A final quarter seem to have no real conclusion other than they should carry on with their work (see ‘more research is indicated’). However. while IMRAD is a useful structure for authors to follow. and draw attention to the main trends. and therefore if you want to communicate with them then you must conform to that structure.IMRAD STRUCTURE • Methods – or what did we do? This section usually consists of about six to seven paragraphs. The final sentence should be conclusive. be one of several influences affecting the publication of scientific papers’ (Winning the publications game – see scientific papers booklist). Sometimes there may be as many as seven to eight paragraphs.. Wherever possible prefer the inverted triangle. with each paragraph dealing with a different point (such as the reasons for the link and how this relates to existing theories. You need to comment on these. each dealing with a particular aspect. the day-to-day implications for clinical work. the implications of this finding to medical science and society. (The abstract doesn’t help. Avoid woolly phrases like ‘within five minutes of Birmingham . This section is straightforward and describes exactly what you did. However..’ About one quarter are what I have called ‘perhaps possibly’ endings: ‘Left-handedness could possibly. it is not reader-friendly. It will almost certainly refer you to figures and tables. The descriptions should be full enough to allow someone else to replicate what you did. though journals concentrating on pure research may often take longer. etc). Under no circumstances. If necessary divide this section into subsections. under certain conditions.’. • Discussion – or what does it all mean? The first sentence plays a key role and describes the main findings: ‘In this study we found clear evidence that those who write with their left hand are far less likely to have scientific papers published. and in about 50% of articles it does give a clear conclusion or message: ‘Left-handed people should be given extra assistance if we are to expect them to write as many papers as other people.

This should not be a problem if you make sure that you do not write a paper without first deciding where you wish it to be published (see brief setting). copyright and reprints. Integrity See editorial integrity. indeed the instructions should make things clearer and easier. split See split infinitives. the Instructions to Authors are only one part of the picture. can give useful information to those planning where they should target their paper. Such differences. scientific fraud. under the heading of ‘Instructions to Authors’. Most of them go into considerable detail. Instructions to Authors Most academic journals publish a wide range of specific rules on what contributions they seek and how they wish to have them presented (see style guide). One warning.THE A Z OF MEDICAL WRITING – Individuality Some feel that their writing should reflect their own personality. such as the way in which the title is written. with instructions on the size of paper. International Committee of Medical Journal Editors See Vancouver Group. reviews and letters to the Editor in the fields of research and teaching in epidemiology’. on the other hand. however: when it comes to working out the precise market requirements of a journal. the instructions in the International Journal of Epidemiology state that the journal ‘publishes original work. it is vital that you obey these instructions to the letter. The trouble is that they end up writing to please themselves. or the favoured style. From the writer’s point of view. not the reader (see false feedback loop). They also give useful insights into the culture of a journal. 64 . and published in each edition of the journal or at regular and wellpublicized intervals. For instance. although subtle. and the number and style of references. that can be discovered only by careful analysis of the papers published in your target journal (see evidence-based writing). Infinitives. The European Journal of Epidemiology. how to lay out the first page. There are many aspects of a paper. ‘serves as a forum on the epidemiology of communicable and non-communicable diseases and their control’. These are drawn together.

Check your equipment: most writers have etched on their memories the disastrous times when they discovered that their tape recorder had broken. three reasons for an interview: (1) to get facts and information. or had to borrow a pen or some pieces of paper from the interviewee. and (3) to provide information for a profile of the interviewee. Make your interviewee feel comfortable. For each of these. you will need a different set of questions. But don’t get tied into a long list of questions: using a summary rather than the full list will help you to be more flexible. Once you have found your interviewee. depends on how well you have chosen the person to be interviewed. because it is informal and spoken. and in a language that. Keep the interviewee on track. the more likely you will be to get good quality information. • Give a good impression from the start. however. The best way is to ask other people. the following step-by-step plan should be helpful: • Be absolutely clear before you start what you want to achieve. and use this to construct a checklist of questions. • Prepare the interview carefully. Watch for biases and hidden agendas – and if possible balance one expert with another. (2) to add opinion or description to facts that you already have. is more likely to pass the pub test and be accessible to the target readers. Start with some small talk and easy questions. broadly speaking. The quality of an interview. Group these questions into three or four broad areas and either memorize this summary or write it down on a piece of paper. Interviewing The ability to carry out a good interview gives writers a valuable tool. Don’t go to the experts only. in a way that will not restrict you later. These should be negotiated before you start rather than when the questions start getting difficult. It enables them to gather information quickly from those who have expertise in a given area. Follow your agenda. you need people who can communicate in clear English. This is the time to set any ground rules (see off the record. 65 . non-attributable information). not that of the interviewee. Interviews are not the time to make a fashion statement: the more acceptable you appear to the interviewee. • Throughout the interview remain firmly in control. There are.INTERNET Internet See World Wide Web. Use a technique such as branching to work out the information you need.

just in case there is a systems failure. you should be in a position to take out of it.THE A Z OF MEDICAL WRITING – though sometimes desperate measures may be needed. but the quality of the information elicited. or the liveliness of the quotes. 66 . Make a checklist of important points. Intro This is the term used by journalists to describe the first sentence of a news story. • Review what you have been told as soon as possible after the interview. such as ‘Anything else to add?’. Introductions Many people believe that the role of the first part of a piece of writing is to introduce the reader to what you are going to say so that the reader can decide whether or not to become involved. The danger with this is that they will try to get rid of their bright. If readers don’t become involved in the first sentence. If you come out of your interview feeling humiliated. The test of a good interviewer is not what the interviewee thinks. Interviewees will often ask to see a copy of what you have written before it is published. such as knocking over a glass of water. Wherever possible go through the information as soon as the interview is over. Use your discretion: a sensible compromise is to read what you have written over the phone. It is constructed using the inverted triangle model. clear quotes and try to put back their posh overcoat (see putting on the posh overcoat). they almost certainly won’t become involved in the second (see intro. When you come to write. ‘Should I talk to anyone else?’ and ‘How can I contact you within the next 24 hours?’. This probably stems from school essays and has a slightly old-fashioned feel to it. don’t worry. In that way they can pick up errors but will have no time to fiddle with the style. For most types of writing (though see IMRAD above for an important exception) use the first sentence far more aggressively. passing your copy to them will probably pick up one or two errors of fact. what you need. inverted triangle). • Close the interview in a positive way. Avoid where possible writing up transcripts: this takes up huge amounts of time. as a hook to get the reader’s interest. On the other hand. from memory. Using a tape recorder will free you to concentrate on the business in hand – though keep some written notes as well.

A slightly different type of writing.INVERTED TRIANGLE Inverted triangle This is the structure. obesity and other people’s fast cars – we are all against. Doctors talk of ESRs and perinatal mortalities. Jargon This is one of those things that – like smoking. I can confirm that I have investigated this matter fully and comprehensively and will now endeavour to clarify the points you raised. and I think are better described as gobbledegook. It is based on the assumption that your best chance of being read is to put your finest information into the first sentence. Once you have done that. The occasional (or perhaps more than occasional. but is meaningless to outsiders. and in the mid-19th century the famous war correspondent Russell could use the phrase ‘the jargon of the campfires’ in his description of the scene on the night before battle. or even for the wrong audience (see false feedback loop). But it is not a clear concept.’ This is not a technical language. All have meanings within their group and are useful because they can describe complex notions and ideas in a simple way. Jargon (as opposed to gobbledegook) has proliferated because of the increasing tendency to write one document for a number of different audiences (see effective writing). also called the news pyramid. Much of what we call jargon today is actually a technical language that has a precise meaning for fellow professionals. in respect of your dissatisfaction with your recent holiday in our facility. The difficulty comes when these terms are used inappropriately to the wrong audiences. depending on the papers you buy) lapses into extremity should not distract from the fact that this is a sensible approach. is the flabby and pompous: ‘Further to my previous correspondence. in order of importance. you can put in all the qualifying information. It is derived from a French word that described the twittering of birds. also called jargon by some people. Sociologists talk of normative structures and anomie. and we should adopt it for many types of writing up to about 400 words – particularly letters. taught to generations of journalism students. Trainers talk of talking walls and problem-based learning. emails and executive summaries (see marketing). The answer is not to get rid of all 67 . but a succession of empty phrases.

Journalists use it to describe words that are so over-used that they have become clichés – from ‘official sources revealed yesterday’ to ‘top docs probe mercy dash blaze horror’ (see journalism). 1992. 1994. tell it economically and quickly. the writer’s guide. London: Longman. If we do this. can put across immensely powerful public health messages.THE A Z OF MEDICAL WRITING – these uncommon words completely. Abingdon: Radcliffe Medical Press. if understood and used properly. • Communicating science: a handbook. It also provides major opportunities for putting out important public health messages (see press releases). BOOKLIST: journalism • The fight for public health. At its best the exposer of unprincipled villains and deposers of evil regimes. A must for doctors who wish to influence public health. speaking or ‘meeting the media’. the practice of journalism provides some useful lessons for those wishing to learn how to communicate effectively (see tabloids). • Medical journalism. Journalism At its worst the hounder of innocent princesses and enemy of sensible government. Whether you love it or loathe it. whether by writing. by Michael Shortland and Jane Gregory. by Simon Chapman and Deborah Lupton. 1991. but to make sure that we use the right language for our audience. by Tim Albert. Journalese Doctors often use this word as a general term of abuse for vulgar and sensational writing. 68 . If you want to risk one. This book tries to explain how doctors can learn to write for magazines and newsletters rather than journals. London: BMJ Books. Written by two experienced campaigners it shows how the mass media. the jargon problem will go away. Test it on someone else before launching it to the general readership – and believe them if they say that it’s not funny. An excellent and provocative book intended to cajole scientists into communicating properly. Jokes It is difficult to make these work in the unforgiving black and white of the printed word.

but some in partnership with professional associations. Robert Campbell and Jack Meadows. Unlikely to help anyone with their writing problems. Originally set up to inform ‘artisan countrymen and merchants’ of the developments of science. by Brendan Hennessy.JOURNALISM • Writing feature articles. by Barbara Gastel. Cambridge: Cambridge University Press. The standard work. 1997. review articles. Dr Gastel runs a master’s degree programme in science and technology journalism and this is a useful account of what is happening in the United States. • Peer review in health sciences. they later narrowed their focus to smaller and smaller groups of colleagues. edited by Fiona Godlee and Tom Jefferson: London: BMJ Books. they have played a key role in validating science (and scientists). this book has a range of provocative and entertaining articles on all aspects of medical 69 . 1989. We are in for some dramatic changes. and (with luck) the return of journals to their original purpose of communicating exciting advances of knowledge. Professional exposition of how to write feature articles for newspapers and magazines. They contain a blend of material. such as the fact that space to publish is limited and that reviewing can be done only before publication. Oxford: Heinemann. the need to understand effective writing will not go away. • Health writer’s handbook. Iowa: Iowa State University Press. through the development of peer review. 1998. such as editorials. obituaries and news. 1991. letters. 1999. most run by commercial organizations. London: BMJ Books. Journals BOOKLIST: journals • Journal publishing by Gillian Page. edited by Stephen Lock. but what distinguishes them from magazines is that they include scientific papers sent out for peer review. More recently. One of the most likely scenarios seems to be the increasing use of electronic publishing to validate science. All over the world thousands of journals are published each year. In the last few years electronic publishing has challenged a number of assumptions. Published to mark the retirement of Stephen Lock as editor of the BMJ. Whatever happens. but will delight the fans of peer review. • The future of medical journals.

KISS Keep It Short and Simple.’ They are important. Kill fee If a commissioned article is returned unused authors will sometimes receive a kill fee to compensate them for the time spent (see commissioning).THE A Z OF MEDICAL WRITING – journals. unread and adding nothing to the sum of human knowledge. Latin education 70 Not a good preparation for those who want to be able to write effective contemporary English. If you don’t have the right key words. the current editor. Readability. Journalology The word used to describe the study of matters of interest to editors of learned journals. Key words These are the half dozen or so words that you need to include with an article in order to aid electronic retrieval. rarely figures highly. It is particularly interesting to look back at how Richard Smith. then all the work you have done will float out on the electronic highway. and scientific fraud. These include authorship. And there’s no better guide than this if you want to cultivate an effective writing style. Terms from the medical subject headlines (MeSH) list of Index Medicus should be used. It encourages a . reviewing. alas. predicted the development of journals. The Vancouver Group define them as ‘key words or short phrases that will assist indexers in cross indexing the article and may be published with the abstract.

The difference is usually made to seem greater than it is by the use of jargon. It also encourages the peculiarly ornate constructions favoured by Latin textbooks: ‘Having attacked Labienus with arrows. But those who insist that ‘data’ are plural are unlikely to say ‘We should renew our insurance premia’ or ‘Please turn to agendum number one. partly because it is in both your interests and those of your organization to keep a consistent image. ‘participate’ rather than ‘take part’.LATIN EDUCATION nostalgic loyalty towards Latin and Greek words rather than the Anglo-Saxon – ‘commence’ rather than ‘start’. spelling). Finally. Latin plurals Insisting on these has become an affectation. Cotta rolled bundles into the ditch’ (see dangling modifier). The only consolation is to think of all the things you did get right (see proofreading. 71 . Here are some principles. Many people like to feel that they need to exercise their individuality and therefore must ignore any style laid down by the organization they work for. Latin is no longer a developing language and therefore can encourage the delusion that language has immutable rules (see pub test). Those who have decided on your corporate image will usually have had training in design and therefore will probably have a better idea of what works (not that you will believe them). Layout How we lay out what we write on a page has an enormous influence on how it will be received.’ Be guided by common usage and ignore the snobs. Lay person A put-down by those in one group to describe members of another. Lawyers It is usually best to avoid their interventions (see copyright. and you can ruin much hard work by thoughtless presentation. Law of late literals At least one mistake in every piece of writing will be discovered once it is too late to do anything about it. • Follow the style of your organization. libel) – but beware falling into the trap of defensive writing. Resist this temptation.

get rid of some words. Leaf shuffling Leaving things out The real problem in writing is leaving things out. not to interrupt them. Word processing packages can do all kinds of wonderful things and. if you made a mistake. and not what you want to give (see brief setting). 72 . not putting them in (see leaf shuffling). Look at publications you enjoy reading. Length Depends on what the reader can take (or what your editor thinks the reader can take). There are few remaining excuses for the illegible scribbled note. Make sure the margins round the outside of the page are wide enough to give an air of organization. they get a whole pile of leaves (such as data or references) and start moving them around. It rarely advances the writing process. Avoid white space between paragraphs. • Avoid crossings out. And keep to them: don’t change the margins in order to accommodate extra words. Research on readability is clear: it doesn’t matter which of the main typefaces you use. Some people write as if they were building a tree. can make things much easier for the target reader. too. provided you don’t get carried away. You may wish to use a second typeface for headings and other devices. as long as you use it large enough (12 point if you are using the width of an A4 sheet) and don’t play around (see polyfontophilia).THE A Z OF MEDICAL WRITING – • Use white space carefully. and those you should read and don’t. • Choose one main typeface and stick to it. and see what design differences there are. This is an interesting form of writer’s block. And around. White space should be used to frame words. and sends a strong message that the writing and thinking will be messy. • Make the most of modern technology. But instead of starting with the trunk and then adding the branches. So there should be no excuse for submitting copy with handwritten amendments: it looks messy. but don’t overdo it. And around. In the old days. you had to get out a bottle of correcting fluid or simply tear out the sheet and start again. particularly since those who suffer from this affliction can plead that they are meticulous researchers. Now all you have to do is make a change and run off another copy.

for instance. Immediately after your cough. do worry about being pompous.. and use a reader-friendly layout. • Leave it overnight if it is a sensitive matter. in which case you can consider it a success if you hear no more about it? Or is it to invite someone to do something. It could be a lawyer. Important letters are worth taking time and trouble over. but you will normally find it worth the effort. Don’t spoil it by. Leave it for a while. Once you have decided on your audience. but don’t overdo it. • Cough if you have to. The principles are generally the same as for other formats (see process of writing). sign the letter yourself. like the complaint about the poor service on the flight. Being clear about this before you start will help you to avoid failing to please either. 73 . are relatively easy. This should not be seen as an opportunity to impress (see putting on the posh overcoat). use the words and constructions that you think he or she will be comfortable with. • Be clear about what you are trying to achieve. the person to whom you are ostensibly writing the letter will not be your real audience. • Use the right tone. or your superior. ‘It was good to see you’. • Give your message as soon as you can. In a few cases. Follow your house style. cramped margins and tiny type.LETTERS Letters We all write these. that will give the first impression. or ‘I am writing to . in which case your success can be measured by whether they do it (see brief setting)? • Be clear about the real audience. Is the purpose of the letter to answer a complaint. It is considered polite in some English letter writing circles to preface your remarks with a polite cough: ‘Thank you for your letter’. not the words. Unless you deliberately want to scare off the recipient of your letter (see political writing). but the following specific points should help. Whenever possible. tell the reader what is going to be in it for him or her: ‘ I am delighted to say that your complaint has been upheld’. Remember that it is the design. others (like answering the complaint) are less so.. This is fine. write as if you were speaking directly to him or her. Brevity of course always takes a little longer. Some. or ‘I am writing to you with an invitation to invest £1 million in my institute so that we can finally find the cure for the common cold. • Exceed one page at your peril. • Take care with presentation.’ • Use the language of your reader. so do what they ask. for instance. Don’t worry about being patronizing.’. Most people say that they like one side of paper only.

Stupid things happen. Go for the big picture: avoid the carping letter full of little gripes. ‘This man is a little odd: placate him. and are often more widely read than longer pieces. Those who write in this way are often surprised that they can do it. This applies particularly to letters written in anger: by the next day a less confrontational alternative will usually have suggested itself. See scientific fraud. resignation letter. They are different from the covering letter accompanying articles. And if you can. saying. • Put it in the right envelope. Libel Lies This is defamation in written form. Light touch A gift from the gods and relatively rare. Letters to the Editor These are usually fairly short pieces of writing (two to three paragraphs) submitted for publication. Many people look down on them. See also covering letter. and work out how long (or how short) it should be. to see how their work is used.THE A Z OF MEDICAL WRITING – preferably overnight. But be careful (see jokes). or the letter with the post-it note still attached. while those who can’t will never believe they can’t do it. Lists Many people like to make lists before they start to write. They also bring the writer to the attention of the publication’s editorial staff. You will have few words to play with for this so weigh up carefully what you need to say. Work out what you want to achieve. end on a note of humour. They are making some attempt at planning. which may lead to an article being commissioned in the future. and. Look carefully at the letters in the target publication.’ Be careful. They give people the chance to write for publication. which is good. Generally it cannot be taught – but this isn’t the same as saying that those who have it don’t need to work at it (see rewriting). if accepted. But lists 74 . and what message you want to give. like the welcoming letter that gets posted to the rejected candidate. which is a shame because they are difficult to do well.

Long sentences Difficult to do well.LISTS can be limiting: they are one-dimensional and tend to establish links between thoughts and ideas that can be difficult to alter. Since the quality of writing in journals is usually extremely poor (see style). sometimes centuries after it first appeared. this is a clever piece of marketing on behalf of the academic community. Some teachers on effective writing techniques now recommend more flexible ways of planning (see branching). Those who think they can do them well are usually mistaken. It has usually been written because the writer has some kind of impulse to write. Literature (2) A word also used to describe what appears in scientific journals (as in: ‘a study of the literature reveals ..’). Long words overcoat). where the purpose is not to please the writer (or satisfy his or her demons) but to put a message across to a target audience (see effective writing). balanced feedback). rather than throwing at it all kinds of detailed but minor difficulties (see micro-editing. 75 . Favour shorter ones (see putting on the posh Macro-editing This refers to the under-used technique of asking one or two major questions when you are considering a piece of writing in draft.. It differs from the kind of writing dealt with in this book. Literature (1) The term used to describe a piece of writing that is still read and valued. because of some enduring qualities that are often hard to define.

common in scientific publications. however. If you are rejected. not you. • There will rarely be Instructions to Authors. elevator manufacturers) often without charge. from crosswords to racing pigeons. such as the letters page. from home makeovers to genealogy. As a contributor you may disagree with some of these changes. you will not receive reviewers’ comments explaining why. The basic principle of writing for a magazine is similar to that used for writing for a scientific journal: identify your market. • There is no peer review system. greater use of colour and fewer topical news stories. create your product. marketing). of printing detailed instructions. Most magazines depend on professional contributors. and therefore forgo the practice. and from health to horoscopes. Use the process of writing as outlined elsewhere in this book. If you feel that the subediting has altered your 76 . This means time and effort spent on subediting. The best place to start is those magazines to which you subscribe because presumably you will share the interests and language of the readers. (such as doctors. A good editor will often seek a second opinion (or third or fourth). You will have to work out for yourself what gets published. • The ‘consumer’ press comprises publications sold over the counter and dealing with all kinds of leisure activities. are the experts in what their readers will be expected to read. Traditionally magazines have been divided into two groups: • The business press comprises publications sent to specific groups. and not go through a panel of unknown (and therefore unpredictable) reviewers. special slots such as ‘Soapbox’ or ‘Open Door’. Magazines have to compete with each other for relatively scarce readers – and therefore they go to considerable lengths to ensure that articles are presented in the way they think their readers will like. and sell it. and why (see evidence-based writing. Now the differences are becoming blurred. But bear in mind the following points. Look for the places where the editor encourages contributions. • Readers are considered much more important than authors.THE A Z OF MEDICAL WRITING – Magazines A decade or so ago it used to be easy to distinguish between a magazine and a newspaper – generally the magazine had a picture on the cover. More and more of them have slots for health-related issues. lawyers. more illustrations inside. or competitions. but the subeditors. but will do so informally. This clarifies your task: you have to please the editor.

make sure that they share in the warm afterglow. allied with a light-hearted awards ceremony. Most publications have standard amounts. Managing upwards Unless they also own the publication. These do not have to be artificial situations like go-karting or rock climbing. editors are employed by an individual or an organization (see bosses). people come together in a relaxing situation. The following techniques are useful. They are important because it can give both parties warning if conflict seems to be brewing. • Many magazines will pay for contributions. consider informing them in advance. If you cannot live with the changes. • Don’t provide unpleasant surprises. This is very time-consuming and causes many delays and hours of aggravation. • Hold regular meetings. but the recent history of journals is littered with the firings of editors who had failed to get on with those who had power over them. This seems fairly self-evident. These sessions could be formal or informal. It is therefore an important part of their role to make sure that they can count on their support. Build up a culture where. 77 . has failed to be clear enough in the first place. Rates will range from about £60 for a small contribution to a small publication to £200 or more for a major national magazine. • Few magazines will send you a proof in advance of publication. • Invest time in getting to know those who could fire you. If you want to do something controversial. • Share your successes. but perhaps a reception for contributors. there are two possibilities: the subeditor is incompetent (but why has he or she not been fired already?) or you. the author. The larger magazines (in terms of circulation) will almost certainly pay for publication. • Have fun. Few magazine editors feel that these disadvantages are outweighed by the advantage of spotting one or two errors. as they surely must. at least once a year. The people we are talking about are not in their posts because of philanthropy. they are there so that they can feel good and successful.MAGAZINES meaning. though preferably when it is just too late for them to stop you. usually minor ones. When things go right. so it is sensible to inquire before you write what you will be paid. seek other outlets for your creativity.

if you want your readers to emerge with a message and 78 . or by examining the way articles are presented (see evidencebased writing).THE A Z OF MEDICAL WRITING – Marketing The kind of writing we are talking about in this book is really marketing – of a piece of information we want to put across. and is meant to change group behaviour. and by studying the Instructions to Authors. Writing for these papers is an excellent way of learning the crafts of writing and of dealing successfully with editors. make sure your message is clearly stated in the first sentence (see inverted triangle). but there are other areas where they positively welcome feature articles written by readers. This has important implications for the writer – in particular it stresses the importance of defining our customer at an early stage (see setting the brief). Medical newspapers Doctors are particularly well served by professional newspapers (some would say too well served) mainly because of the advertising support from pharmaceutical companies. This means that we can do market research on what he or she seems to like. I suspect that these newspapers are more influential than many would like to believe (see Pulse phenomenon). Perhaps a quiet word. Memos The person-to-person memo has largely been superseded by e-mail. The editor becomes a customer. not a judge. make sure you are clear before you start what you are trying to achieve. This approach is reassuring when it comes to writing scientific papers. Most parts of these papers (such as the news sections. will do the trick instead? If you do decide to go ahead. This still leaves the ‘public’ memorandum. We no longer have to think in terms of passing some quality mark (see Icarus fallacy). Message A fundamental principle that runs throughout this book is that. They also provide excellent opportunities for doctors who want to write. which comes down from on high. editorials) are written by the paper’s own professional staff. or a good party. sits at the corner of a notice board until the ends start to curl. or a request for help of some kind. by running a literature search on the topic in that journal. As with all other types of writing. or simply some advertising for ourselves and our abilities. but instead can view what we write simply as a product that has to be sold.

are largely ignored (see leaf shuffling). One of the hardest parts of writing minutes is defining how they can be seen as successful. even) of papers that. but in a rarefied way that makes them a prime example of political writing. Methodologists They currently enjoy considerable influence with the editors of medical journals. One of the certainties. the complaint is usually made for completely different reasons). it involves focusing on details rather than important issues. or not. Minutes These record what happen in a meeting. See brainstorming. branching. For these reasons. In some organizations.MESSAGE act on what you have written. This should be taken as part of the game. Micro-editing This is the more common approach to giving comments on what others have written. particularly those with a full-time secretariat. though most will encourage the use of the passive voice. however. 79 . Unlike macro-editing. use action lists wherever possible. is that at the next meeting someone will complain about the accuracy (not that they are inaccurate. Mindmapping The theory and practice of a type of brainstorming devised by Tony Buzan. This may explain why there are thousands (millions. While no one could sensibly condemn the view that we should make sure that our researches have been conducted properly. Organizations will vary in their preference of style and structure. and not an indication of failure. It is overused (see balanced feedback). writers of minutes may find themselves torn between the chair and their head of department. A better indicator is whether the chair (or whoever is holding the meeting) is happy with them. though methodologically sound. then the sensible thing to do is to define that message carefully before you start (see brief setting). there is a danger that dotting every methodological ‘i’ and crossing every methodological ‘t’ can make us lose sight of the fact that writing is of value only if others can read and understand it.

Mission Monologophobia A term first coined by Harold Evans. distinguished editor of the London Sunday Times. and to empower individuals and teams in a proactive. it was discovered in the studies’ leaves the reader not quite sure whether we are talking about one piece of work. probably because many of them are written by committees. the investigations resulted in .. proofreading). One first 80 . For example: ‘Our Mission in the Human Resources Division at St Bede’s NHS Healthcare Trust is to foster and encourage the development of Individuals and Teams throughout the Organization in order to effectively satisfy the needs and priorities of those entrusted to their care. badly.. This fear is common. preferably within four hours of arrival. Often the repetition of a word is a strong sign that the sentence could be improved. if you wish) should clarify. as in ‘the vicar ran for a male’ or ‘We went to Pisa for a wee and half ’ (see law of late literals. It should also improve the likelihood of everyone working together for the same end.THE A Z OF MEDICAL WRITING – Words on the printed page that have turned out wrong. A well-written mission statement (call it something else. When you carry out a group activity. These can give great pleasure. doubtless conditioned by a torrid time at school (see post-spelling bee traumatic disorder)..’ But strip away the pomposities and the platitudes. It is the fear of using the same word more than once within several lines of itself. Later it was adapted to describe those sent overseas to spread a religious message. Over the past decade or so it has been adapted yet again. but often at the expense of making the text readable: ‘The research indicated . They may find these words. Some people. and there is a good idea in there. feel that part of the challenge of writing is to find alternative words. fulfilling and measurable manner. it is a good idea to sit down beforehand and work out what you are trying to do.’ Mission statements produce a strong reaction among medical folk. to describe the practice of writing down the purpose of an organization: ‘Our mission at St Bede’s is to treat people with hand injuries. otherwise others will think poorly of them. not confuse. Misprints A few centuries ago this word (derived from the Latin verb ‘to send’) was used to describe a group of people dispatched overseas to conduct diplomatic negotiations. or several..

Instead give the message – a simple sentence outlining the implication of what you have found (see final sentences).. 81 .’ to the more ingenious ‘Further analysis of the pharmacology will be required to further elucidate the exact role of this mechanism following this type of insult’ or ‘Further investigations are needed employing various transgenic mice to completely clarify this mechanism. moving from the relatively simple ‘This study demonstrates the urgent need for further investigation .’ If you wish to conquer your monologophobia. writing chapters in). ‘More research is indicated’ Multi-authored books of. If they say you are repeating words (and it is annoying them). As you come towards the end of the rewriting phase. don’t give it a thought as you do the first few drafts. they will almost certainly point out to you if repetition is getting in the way.. ‘Try. try. books. if you give your writing to someone else to read. then do something about it. and try again’ works much better than ‘Keep trying. See evidence-based writing. In fact repetition can be a useful device to add emphasis.’ One of the great clichés in contemporary science writing. you may wish to keep an eye out for undue repetition. Yet there are few signs of this banal sentiment disappearing.MONOLOGOPHOBIA step would be to turn any passives into actives: ‘The study showed three things.’ For a more powerful conclusion. At least authors are starting to dress it up. editing Myths These abound when it comes to defining what makes ‘good’ writing. These abound (see books. avoid concluding with the predictable wish that your researches be allowed to continue.

Incorporate the proposed changes. Negatives Prefer to say what is rather than what is not (see positives). we do not have to negotiate.’ See also double negatives. We have a formal relationship with these people. and thank your co-author graciously for the helpful contribution. It is therefore not always possible to dismiss their proposed changes out of hand. and should be approached with care. which divides comments from co-authors and bosses into three groups. because we do not have to follow their suggestions. even if we have reason to believe that these changes will ruin any chance our writing might have of putting our message across to the target audience (see false feedback loop.THE A Z OF MEDICAL WRITING – Names The only thing more important than getting these (and the titles that accompany them) right is making sure you publish the right dosages. • Changes that will reduce your chances of getting your message through to the target audience. and they include adding unimportant matters of detail and substituting someone else’s style for yours. it’s seen as the function of a boss or co-author to make what they disarmingly. Incorporate these changes also. the situation is different. and often wrongly. As before. My colleague Pete Moore has suggested a kind of triage. found in an early-ish draft of this book: ‘Don’t automatically think that because you don’t like what is written it will not have any good effects. if you can. Avoid strings of negatives – such as this one. 82 Negotiating changes . Some comments will fall into this category. proofreading). These are the changes on which you must concentrate your diplomatic skills. When we submit our writing to co-authors and bosses. • Changes that will help you to get your message across to your target audience. These are the most frequent comments. Be rational. • Changes that will have little effect on whether your message gets through to the target audience. It will help enormously if you have already agreed with these people the overall message and the market (see brief setting). This is therefore a key part of the writing process. call ‘corrections’. not emotional. thank them profusely for their contribution – graciously. When we ask friends or colleagues to give us feedback on what we have written. however. But they are still likely to propose changes: after all.

A proposal to start up a newsletter was met by the comment. If you are getting proposed changes from more than two people. you will find that some of the proposals are in direct conflict. you should be in a position to hand them your work not for detailed textual criticism but to answer the simple question: ‘Can you live with this?’. 83 . Ideally. incorporate the suggestions from the most powerful adviser. Part of the impetus came from the growing number of computer programmes that included templates so people with no formal training in editing could set up a newsletter. Ask for advice on dealing with this. • Do not set up a newsletter unless you really need one. so as a long-term goal you should consider training them. in your view. there should be a mechanism for getting rid of the editor if he or she oversteps the mark (see editorial integrity). to sell more products. Newsletters There was a time. which at least have the advantage that nobody can see them unless they actively search for them. He or she should be allowed to get on with this job. as long ago as the early 1990s. Anyone who was anyone had one. But they need to be well done: we are surrounded by high quality publications. The editor should be responsible for all the content of the newsletter. However. and at the first whiff of a communications problem. are likely to turn off the target audience (see above). Define the need carefully – to improve morale. ‘Not another!’. And everyone turned to setting up websites. though don’t point out that the problem is of their making (see evidence-based writing). For those who still wish to persevere. here are some simple principles. and those that don’t come up to those standards look tawdry. without interference. Co-authors and bosses should not be commenting on minor matters. and (2) other things being equal. Don’t just start because it seems (or someone else says it seems) a good idea. This is a pity because newsletters can be extremely useful.NEGOTIATING CHANGES Provide evidence for your contention that the proposals could make the writing less effective. In these cases you must assume a slightly different strategy. someone threw a newsletter at it. Inevitably newsletters began to fall into disrepute. when newsletters were all the rage. and give him or her space. I would suggest two general principles: (1) try to negotiate away any suggestions that. to encourage former students to leave lavish bequests (see mission)? • Appoint an editor.

or are the GPs getting fewer trivial phone calls after hours? It’s not always possible to have such definite measures. Work out which items will go where. • Lay down a structure for the publication. Work out how many editions you will have for the next year. This is usually caused by a failure to plan ahead. This sounds obvious. editorial and letters on the second page. For each edition plan backwards with key dates. • Keep the design simple. Surveys generally have a poor response rate. Producing a newsletter should not be a way of showing off what your new computer can do. not just for the first edition. It also helps editors by enabling them to collect specifically for each section (see commissioning). Try to attract their attention with intros and headlines. have the courage to propose closure. This could be some 84 . Many publications end after a few editions. If the newsletter is not working. for instance. Keep reminding readers why they have made a good decision to read the newsletter. Other techniques could include observing how piles of the newsletter go down (and the contents of the waste paper baskets fill up!). and that end is to get people to (1) recognize the publication (hence the need for consistency) and (2) read items contained therein (hence the need for clarity and display). fewer nuisance telephone calls). • Measure what you are doing. completed pages to be printed (see deadlines). Alter the running order with reluctance: readers like stability because it helps them find their way around. Separate fact from comment (see Pravda effect). a feature article on page three and some smaller items of interest and a mini-profile on the back page. such as articles written. For example. for instance. you should be able to work out some way of recognizing when you get there. put news stories on the first page. more sales. with a bias towards the discontented. but if you are setting up a newsletter to achieve something (better morale.THE A Z OF MEDICAL WRITING – • Set down annual schedules. or health professionals rather than patients (see committees. articles edited. Consider performance measures instead: are more people phoning the help-line you have publicized. articles laid out. but for subsequent editions as well. Design is a means to an end. • Write for the real readers. and when you want them to appear. • Trumpet your successes. but many newsletters end up being written for the ‘wrong’ people – the management team. rather than the average employee. false feedback loop). Choose a layout that you can use without too much trouble.

though one of my favourites. Non-attributable information The information given to a journalist on the basis that the source will not be revealed (see also off the record). Not only . 85 . Newspapers Like newsletters... though more widely read and with greater resources. News pyramid News story See inverted triangle.. A newsletter that outlives the first editor is a real success. • Identify the next editor. don’t be bashful – report it. aunts. the list is long and fascinating. chopsticks. daffodils. Vivid writing contains many of them: bricks... tabloids)..’. and an extremely effective way of putting across a message. elephants. But that’s not sufficient reason to dismiss what can be a very effective way of putting information across. Nouns Words that describe ‘things’. but also A cliché. Choose and groom a successor. etc. The currency of newspapers. The key to the technique is to define the message or ‘story’ in the first sentence (see inverted triangle). ouija boards . neurons. pencils. This can be a problem to those who have been trained in science writing because they are unused to giving such prominence to single messages (see IMRAD structure). It’s worth studying them to find out why (see medical newspapers.NEWSLETTERS bare facts about how many people now receive it. letters to the editor (even negative ones show that the publication is read) – or a success story from a previous issue: ‘Anne Smith lost her left shoe – but within minutes of this newsletter coming out she was reunited with it . that would include people and ideas as well as material objects. If you win a prize.

86 . This can be asking for trouble. If you are unfamiliar with the publication. • Make sure that you are fully briefed. mistakes get through. and the greatest insult is to carry them from obituary to obituary without checking. even better. surviving relatives generally find it helpful to talk about their late loved one. Obituaries Obituaries are difficult to do well. Be inspired by what others have written in other publications (such as the daily newspapers). make sure that you read it carefully. With the best will in the world (see cliché). while avoiding conferring an instant sainthood on the other. You have to do this in a way that interests readers. Look at other obituaries in that publication. You will have to avoid giving offence to grieving relatives on the one hand. see if there is a recent CV. You have a few hundred words to summarize a lifetime of achievements. • Gather the facts. Finally. speak to a close relative: don’t worry that they might find it upsetting to talk. most of whom until this moment will have lived in ignorance of the deceased. and style.THE A Z OF MEDICAL WRITING – Noun salads The practice of stringing together a dangerous number of nouns. Somebody with a Latin education has written somewhere that this is the appropriate word to use for the advance described in scientific papers. How many words and by when? If the publication provides written advice. paragraphs. In my experience of writing obituaries for local newspapers. Distinguish from ‘the novel’ – see literature and proceed with caution. noting particularly first and final sentences. Try to find an entry in a publication such as Who’s Who. but don’t rely on their accuracy. Speak to one or two colleagues or friends. as in: ‘Hospital patient attendance officer returns audit.’ Novel As in ‘a novel treatment’. Now it has become a cliché: everything is novel where I suspect ‘new’ would be perfectly acceptable – and more in line with current usage. make sure that you know who the target audience will be.

not generalizations and bare qualifications. you also owe it to your readers to paint an honest picture. In some ways the best person to do this will be a close relative. though places of work could also help. Your research of the publication will have given you an idea of the number of paragraphs or sentences you will require. ever. Here you must make it clear that you are asking them for opinion on matters of fact only. at an award-giving ceremony. Make sure that the photograph is properly labelled: ‘Joan Smith-Brown.OBITUARIES • Work out the broad shape of the obituary. ‘well respected’. like: ‘gentle giant’. Look for photographs taken by professionals. pictured in the surf at a break during the Cornwall GP Trainers conference in 1983. Write down three or four main areas you wish your obituary to cover: for instance. perhaps.’ • Check the facts with someone who will know. and making sure that you have not left out essential details (see process of writing). without breaking off to look at the information you have collected and thinking of your target readers (not the family of the bereaved). • Make sure you are using facts and anecdotes. Use nouns and verbs to add colour: ‘He was at Edinburgh for seven years where he became a familiar figure lounging around the Edwardian lecture halls in his pink waistcoat and green top hat. The most likely source will be the family. Make sure that you have put down facts and are telling stories. Revise carefully what you have written. but they tend towards extremes of undue flattery or unnecessary self-effacement. or even better at a less formal occasion and published in a local newspaper. Take care with your choice: it will be an enduring image. what were the formative influences? What were the main elements of the deceased’s career? What were his or her other interests? And what will he or she be remembered for? Write in one go. This poses all kinds of ethical dilemmas to a conscientious journalist: 87 . checking the facts you have cited. They have not become popular. etc. These are generally accurate and unlikely to give much offence. Take out from your prose any unsupported value-laden words. ‘much admired’. find a photograph. Off the record An agreement between a journalist and a source that the information given cannot be published. While you owe it to the family not to cause unnecessary distress. • Where appropriate.’ One or two journals have experimented with the idea of self-written obituaries.

not just cowardice). that the advice is rather good. The material you then need to put in should select itself (see process of writing). and is particularly appropriate to writing (see process of writing). then. so at some point in the writing process you must order the points you want to make in a linear form. Ordering information Writing has a beginning and an end. noting down what you intend each paragraph to do.e. 88 . then speak on a non-attributable basis. OPERA Only Planning Ensures Real Achievement. that was all off the record. they will be free to report anything you tell them. as long as they have made it clear to you that they are a journalist. sometimes quite trivial. I recommend a less rigid approach to organizing the material (see branching). ‘By the way.’ Ombudspeople There is a fashion among publications to set up one of these. One of those awful acronyms that comes from across the Atlantic. It won’t work to tell them a juicy story then add. Yet the things we agonize about leaving out are generally matters of detail. but not be linked to it (for valid reasons. It is particularly galling. Concentrate on defining the message you want to put across – and then support that message in a plausible and readable manner. The danger in scientific publications is that they become yet another means of enabling disaffected (i. intros. sins of Many people find it extremely difficult to start writing because they fear that they are going to leave out something terribly important. for instance? If you want to give information.THE A Z OF MEDICAL WRITING – what happens if he hears it from another person. by making a (preferably written) plan. Be warned: there is a presumption among journalists that. Before you get to this stage. however. Omission. rejected) authors to take up inordinate amounts of an editor’s time at the expense of the readers. Openings See introductions.

and get an idea of how many paragraphs the audience will be comfortable with. then the paragraphs will also follow each other logically. If you are writing for a newspaper or magazine then your paragraphs will almost certainly be split up. allow one piece of argument per paragraph. think again. Paper publishing). and you should not find it necessary to insert artificial linking sentences at the end of each. or (2) get out paper and pen. A medium whose time is up. If each point follows on logically from the previous point. Few people complain because they have too little to read (see yellow marker test). Passive The passive voice pervades science writing. A paragraph is a unit of thought and generally each should start with a key sentence. despite the pleas of many journal editors to avoid it (see voice). Pain writing). explaining why you are moving the argument forward (see inverted triangle.PADDING Padding If you are putting in extra words just for the sake of it. and start writing anyway (see writer’s block). When planning a piece of writing. There is no point in complaining. after all we shall be judged on what we are about to write. yellow marker test). This is done for visual reasons: long paragraphs and narrow columns are particularly reader-unfriendly. There are two solutions: (1) walk away from the writing and do something completely different. When drafting your plan. think in terms of paragraphs rather than words. or go to your word processor. 89 . possibly (see electronic Paragraphs The basic building blocks for most kinds of writing. Don’t expect to write well without it (see process of Panic attacks It is common to have these during the process of writing. Look at the market you are writing for.

Avoid a posh overcoat and use the language of every-day life (see pub test). However. For those of us receiving it. • Suit the message to the audience. ask advice from a medical legal expert. • Work out exactly what you want to achieve. • Keep the language simple. Printing pictures. • Use illustrations. If in doubt. Patient information If you visit any out-patient clinic you will see a vast amount of written patient information. breaking many of the guidelines long since accepted by professionals.THE A Z OF MEDICAL WRITING – Patient consent Journals nowadays require formal written consent from patients who are being written about. or to produce some kind of tangible gain. this does not mean that you should flout the rules of your profession. but some will remain gathering dust on the racks for months. If you wish to avoid falling into these traps. such as patients feeling more in control of their condition? How can you measure whether you are achieving your goal? With fewer phone calls from worried patients. Write for the patients and not for your colleagues (see false feedback loop). having it in written form gives us the chance to extract information at our own pace. Why are you producing your information? To make you feel better. for instance. drawing diagrams and using other graphic devices will encourage more people to pick up your 90 . though that does not mean that you must avoid simple language. the following principles will help. without the tensions of a quick face-to-face interview. This is not an examination. although some research seems to suggest that written information has limited value. For those putting out the information. or evidence that they are taking their pills at the recommended rate (see brief setting)? • Check to see whether there is any existing information. it gives the chance to consider what they really need to put across. Nor is it a review article in a journal. the potential must be there. in which success depends on you putting out what you know. Yet. In time some will be taken away and looked at. Magazines and newspapers do not: their contributors are not normally bound by doctor–patient confidentiality. This wastes time and money. Avoid being patronizing. Part of the problem seems to be that so much of patient information is produced by amateur communicators. giving an authoritative view of the latest research developments. I constantly see people working hard on producing information that already exists in a better form already.

PATIENT INFORMATION

information and read it. It will also help them to remember the information you put in it (see layout). • Control your costs. The cost of printed information can vary enormously, and the key variable is knowledge of the techniques. Put another way, you can spend an awful lot of money and produce something that is unreadable, and spend next to nothing and produce something that does precisely what you intended. • Make use of your patients. Even writers, designers and printers become ill. Don’t be afraid to enlist their help. Usually they will be happy to advise out of goodwill; they may even find it therapeutic. • Test your information on the right people. Ignore the views of your colleagues – their comments will almost certainly be criticisms of the content rather than judgements over whether you are getting the right messages across. Test any information on the target audiences – ask your patients to read it and then ask for their comments. You could gently probe them to see whether they have taken home the messages that you intended them to take home (see payoff). Remember, this is not a test of your knowledge, but an attempt to put across some useful bits of information to people who are often frightened and confused, and delighted when they receive clear advice.

Patient’s notes

See case notes.

Patronizing language One of the problems of writing, particularly for patients, is that if you use long words you are criticized for not being concise – and if you use short ones you are criticized for being patronizing. This is an area where things may not be as simple as they seem. The original meaning of ‘patronizing’ was to support (from the word ‘patron’); somehow it has moved to a more derogatory meaning, which is to ‘look down on in an obvious manner’. I find it difficult to believe that talking or writing simply, directly and honestly – writing ‘use’ instead of ‘employ’ and ‘flu’ instead of ‘influenza’ – can be interpreted by anyone as designed to make them feel inferior. The tabloids, for instance, use this kind of language – and are rewarded by millions of readers daily. Where language becomes patronizing is not when the words are simple, but when certain phrases are introduced that define the reader as an outsider. Thus phrases such as, ‘what we call’, ‘we
91

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doctors ’, ‘[you] laymen ’. In other words, there is an assumption that the reader will not understand. The solution, I suspect, lies not in changing our style but in having a more robust attitude. If it is your target readers who are complaining, then you can easily make changes. But most of the accusations tend to come from those who have appointed themselves to be their spokespeople (see false feedback loop).

Payoff

Too often we suffer vague feelings of anxiety about our writing. But writing can always be better. The question is: has it achieved what you want it to achieve? When it has, move on (see effective writing).

Pedants

Those who get very upset when someone breaks the ‘rules’ of grammar that they were taught. Thank them, but then think PIANO.

The system of peer review started in the mid17th century when scientists decided that, before they published an article, they should ask the opinion of others working in the same field. The assumption is that exposing work to the criticism of others will identify shortcomings and improve the quality of published material. It is a cornerstone of modern science publishing, with complicated structures developed to carry it out, and more recently a growing peer review research industry giving it added status. Peer review systems vary, but generally, when a writer submits an original scientific paper, it will first be screened by one or two of the journal’s editorial staff, who weed out the blatantly inappropriate or those that have disregarded the Instructions to Authors. Most papers go through to the second stage, which is assessment by others in the field who are known to the journal. Finally the editor, or someone to whom he has delegated this task, will decide, singly or with the help of a committee, which ones to keep. Normally there are more that have passed the quality controls than there is room to publish, so the final decision is generally taken on a subjective decision as to which one(s) are more likely to appeal to the readers (see gut reaction). There have been three major international conferences over the past 10 years looking into peer review and medical journals. Much of 92

Peer review

PEER REVIEW

this research has looked into the best ways of running the system, and into variables such as whether the authors should be told of the reviewers, or the reviewers be told of the authors, or whether young doctors from America make better reviewers than middle-aged professors from Europe (the evidence is that they do). Despite all the effort spent, there seems to be no ‘best’ way. Indeed many of the important questions – such as whether the system can be used to detect scientific fraud, or whether editors would make substantially different decisions without the system – remain unanswered. All this, of course, is of marginal interest to most authors, who simply see the system as a major obstacle to publication. The system, for all its faults, is going to be with us for the foreseeable future, so the sensible approach is to learn how to manage it. Here are some principles. • Reviewers are advisers, not decision-makers. The decision to publish rests with the editor and, although it will be helpful if you have pleased the reviewers, it is probably not a good idea to set out to do so. The reason for this is simple: you will not know who they will be. On the other hand, you do know who the editor will be – and by carefully studying the journal (see evidence-based writing), you will have a good idea of what he or she likes. So it is sensible to aim to please the editor – and hope that the reviewers don’t mess things up on the way. • Don’t get depressed when the reviewers come up with criticisms. After all, that’s what they have been asked to do. But it doesn’t follow that their criticisms are useful, or even right, nor of course that they are always useless or wrong. Judge each comment on its merits and keep a sense of perspective. Try to distinguish between reviewers who throw in additional facts and tamper with the style on the one hand, and those who give useful macro-editing feedback on the other. If you feel that the final decision rests on a mistake made by the reviewers, consider appealing (see dealing with rejection). • The system is not fair. Many writers spend hours complaining about the injustices of the system when they could be learning how to play the game. Editors and their staff may go to enormous lengths to ensure that they treat their contributors fairly. But, as long as journals are run as a business and there are more papers than space available, then the final choice will be made on commercial grounds. • Recommend reviewers when you can. Some journals ask writers to recommend reviewers. You should certainly take advantage of 93

’ PIANO My very own acronym. Flawed and misleading it may be. and there should be no problem as long as you acknowledge clearly what you have done and have sought and received the appropriate permission (see copyright). and it provides a vital principle for effective writing: Put It Across Not Out. by definition. is part of writing.THE A Z OF MEDICAL WRITING – such an offer. the notion hasn’t really caught on. This is the idea that everyone. despite the regular publicity. but it does mean that you get experienced people commenting on what you have written – and all for free. • Use the system to learn. Yet somehow. should write in a way that everyone can understand. however. Perfection The enemy of the published. Tactically. James Thurber put it well: ‘Don’t get it right.) 94 Plain English movement . but of culture and attitude. The question is not ‘Why can’t people write simply?’ but ‘Why won’t their organization let them write simply? (See political writing. Groups have risen up in most of the English-speaking world to push for such reforms. As long as you realize that these comments are almost. This is scientific fraud. putting on the posh overcoat. coming from a biased source. In England the Plain English Campaign is one of them. and there is no excuse for it under any circumstances. In other kinds of publishing you will get nothing like this level of feedback (see journal booklist). much of the writing we get from large organizations is now as impenetrable as it was 30 years ago. get it written. you should include some of their work in the references. it is not a matter of skill. for a fee it will put your text into plain English and award a crystal mark. Actually it’s quite hard to do. Plagiarism The practice of copying someone else’s work and passing it off as your own. they can be extremely useful. Since most of us can communicate simply when we want to. and with one or two honourable exceptions. Citing the good things others have said. especially those who draw up our laws and run our bureaucracies.

Writers should give offence from time to time. The time to take care of them is during the rewriting phase (see micro-editing). It doesn’t matter if you appear to be an unreconstructed bigot at the first draft. there is a valid reason for consciously trying to change the words we use. Thus ‘This pill may kill’ becomes: ‘It has been established in the scientific literature that there is a statistically significant relationship between a 95 . irrespective of whether we think some of the changes go too far. not accidental. Clearly you should avoid them. ‘Gay’ no longer means happy and ‘chairs’ nowadays direct meetings rather than enable participants to sit down during them. Political writing This is the ability to take a simple statement and make it so hard to understand that the reader becomes confused. ignore the normal rules. Use as many abbreviations as you can. Political correctness All around us are examples of how language is being deliberately changed to meet political agendas. but it should always be premeditated. For writers the implications are clear: using inappropriate words may cause people to reject your arguments and (worse still) stop reading what you have written. so long as the final version doesn’t give unintentional offence (though be careful how you dispose of the drafts). ask someone who knows about the political nuances to go through what you have written – and advise if you have inadvertently given offence. Single word ‘asthmatics’ have now become the bulkier ‘people with asthma’. But. and if we want social changes. To achieve.PLANNING Planning Plurals See time management. this. The Lancet’s ‘ombudsman’ transmogrifies into an ‘ombudsperson’ when an article on the appointment appears in a US medical journal. Take a simple statement. Cast it all in the passive. See Latin plurals. Language has a profound effect on how we view the world. then we must change the language being used. Add some peripheral uninteresting information and avoid using one word when several will start to confuse things beautifully. All this makes for easy targets. If you are working in a particularly sensitive field. But suppress any anxieties you might have about this during the actual writing stage.

Some bureaucrats have raised it to an art form. This is not an issue of grammar. Some people feel that an Initial Capital Letter conveys Dignity. most research on writing shows clearly that capitals are hard to read and slow the reader down. Polyfontophilia The love of many typefaces. but this does not mean that you have to use all of them at the same time (see typefaces).THE A Z OF MEDICAL WRITING – premature termination of life and the ingestion. Pompous initial capitals There is great confusion over the use of capitals. Recognize these games for what they are: if someone changes your writing. 96 . dear reader. Modern word processing packages allow us to use a wide range of them nowadays. by the generally accepted route and at doses agreed by the appropriate authorities. and should therefore be used to describe People and Institutions whom we know and value. Thus we talk about Professors and University and Gynaecology and Resource Management Initiatives. They send a strong message that We are Important (though you. thus making us an excellent target for anyone who wants to criticize. Not surprisingly. but it is not effective writing as discussed generally in this book. are not). or that they have done it better (see negotiating changes).’ The technique is extremely useful if you want to give the illusion that things are being done or that you are nicer than you really are. writing often becomes a battleground. Easy to cure (see PIANO). but of style. Also. Pomposity A disease of the over-comfortable. then it risks becoming offensive – and therefore bad communication. characterized by a tendency to use long words and needless phrases. where those who have power give a hard time to those who might wish to wrest power from them in the future. it doesn’t necessarily mean that you have got it wrong. And when we start writing Consultants and Doctors but patients and nurses. Politics of writing When we write we literally put our thoughts in black and white. of this pharmaceutical product.

We are surrounded by them. which suggests that they are an excellent way of putting messages across (see PIANO). ‘He is calm and confident’ rather than. capital letters .. such as ‘commencement’. Thus use (upper case)‘Trust’ when talking about the group of people administering a hospital.e. unless we can trot out long and obscure words – and spell them correctly – we will be judged as dunces. ‘participation’. and ‘residence’. Positives Readers find it easier to cope with what is rather than what is not. This has demotivated several otherwise good writers (see macro-editing). cardboard. But in this context the posters are usually dull and 97 . use lower case – ‘professor . Pompous words These tend to be the longer words.’ Post spelling bee traumatic disorder The surprisingly common fear that. and those coming from the Latin-Greek roots. Committees sometimes get very tetchy about this. department .. university’.. prefer ‘start’. ‘take part’. ‘He is no longer in a sense of confusion.’ For political writing. ignore this principle: ‘We admit that we are in deep trouble’ can be replaced by ‘We are not denying the negative impact of this failure to remedy our deficit situation. Make an exception to this rule wherever there is likely to be major confusion. Other things being equal (see evidence-based writing). Posters A poster is simply a way of communicating information on a single sheet of paper. etc. for example ‘a (and not the) finance and general purposes committee’. a good guideline is to put them in lower case if they can be interpreted as a common noun. in order to preserve (lower case) ‘trust’ for its traditional meaning of ‘having faith in’. Thus. ‘document’. when the individual words become common nouns. ‘report’ and ‘home’ (see also scientific words). however. unique names) such as ‘the Daily Telegraph Professor of Capital Letters at the Department of Pomposity in the University of Oxford’ but thereafter.POMPOUS INITIAL CAPITALS How do we resolve this? The most sensible principle is to use capitals for proper nouns (i. The medical and scientific community has adopted them as an important part of their intraprofessional communication....

Print out your text onto sheets of A4. In many institutions there are specialist departments who will construct these for you. apparently favouring cut-down versions of the scientific paper (see IMRAD). in which case you should look at his or her posters and follow that style. send the file to a specialist printer who will print it out on a large sheet of paper. and that they are there for a purpose (e.THE A Z OF MEDICAL WRITING – badly presented. On the other hand. Many people feel that being creative with a poster involves overloading it with text and different typographical devices. You may be wanting to impress the prestigious research unit up the road. This makes them tough and transportable – even in a normalsized briefcase. Design your complete poster on a computer screen. and not just because everyone says you should have one. Trim your message to the bare essentials. • Use illustrations if they add or attract. you can start thinking about the mechanics. 98 . However. When you have finished. such as limiting your poster to a photograph. Look outside the academic world: use no more than two fonts. who will be at the conference. to grab attention) and not just as ‘wallpaper’. Avoid large sequences of words in capitals. • Print and roll. You may want to influence your supervisor. Print out individual sheets of text and glue them onto large sheets of card. in which case follow their style. one main sentence in bold type. rather than using the medium to its full potential. Content has edged out communication. There are three main ways of producing a poster. • Keep text to a minimum. • Solid panels. enlarge them onto a clean photocopier to A3 and then get them encapsulated. you will be responsible for your poster. If you use illustrations make sure they are good. and are worth listening to. • Small cards. in which case you should consider doing something fairly dramatic. and how they will judge their success (see brief setting). Once you have decided what you want to achieve. and a few numbers. Posters are read (if at all) by people walking around.g. you may wish to make an impact. • Don’t overload. this is not an examination but the communication of a message to someone whose feet are beginning to hurt. They will normally have considerable experience of producing posters. This makes it particularly important for those who wish to present a poster to work out in advance why they are doing it. These can be difficult to carry. or italics or bold. so keep the following principles in mind.

The latest Fowler (see grammar booklist) states clearly that this is a nonsense. Sometimes these ‘mistakes’ actually represent changes in the language. During the communist era the newspaper of this name became a byword for biased stories favouring the controlling elite (see propaganda). different meanings. like ‘differ’. There are several words. There doesn’t seem to be any logic to when they are appropriate. All owners like to indulge their self-interest or vanity. You may be expected to make an oral presentation as well.) • Prepositions at the end of sentences. Finally. Pravda effect Premature expostulation Some people start writing as soon as they have an idea – and before they have done any thinking about that idea. • Different prepositions. as in publishing pictures of their own weddings or writing such blatant sentences as ‘Our distinguished chairman drew on his enormous experience to give a most illuminating address. ‘dissent to’ (instead of ‘dissent from’) and ‘centre around’ (instead of ‘centre on’). so in most cases they have to be learnt. 99 . Here are some common problems.POSTERS • Use the house style. and sometimes would be wrong. (Use ‘differ from’ for comparisons. Many institutions have standard ways of displaying visual material. To some extent this is sloppiness. and ‘differ with’ a person. but there is also a question of usage. Don’t let the prospect of it spoil your trip (see presentations). where the preposition can make a difference. and inoffensively. bear in mind that the poster is only part of the whole thing.’ But such a lack of self-restraint usually ends up making the publication a laughing stock. Prepositions These little linking words can cause huge amounts of aggravation. This is the Russian word for ‘truth’. • Using the wrong prepositions. This can be deeply unsatisfying (see brief setting). Common mistakes include: ‘bored of ’ (it should be ‘with’). Both you and the institution will benefit from the continuity that a house style affords. However. it also gives a warning not to leave the preposition ‘stranded’ from the verb (see style). ‘which they were attached to’). This was one of those rules to which English teachers were very attached (alternatively.

Limit your ideas and limit your material. final sentence). Make a good impression from the start – and end with something memorable. • Use graphics. • What will the audience want to know? How many people will there be? What kind of people will they be and how should you pitch the talk? What will they be interested in? What will they not be interested in? • How long will I have? Allow roughly two minutes per slide. As a general principle. Presentations This is an essential skill for anyone wishing to impress (see marketing). • Where will the presentation be made? How far back will the audience be. • Keep it short and simple. Identify in advance the slides you can leave out if you are running short of time. • Be legible. though not so gimmicky that the audience forgets the main messages (see first sentence. Yet I have seen some dreadful presentations from senior doctors – too much information. which many people feel take a preposition. Show why it is worth listening to you. you will be surprised by how much you were unable to use. then leave a little time for questions. ask yourself some key questions. but don’t. like amplification. Be absolutely clear what you want to put across (see brief setting) to the audience. With a little time and care you should be able to produce a much better effect. When it comes to writing: • Work out your key message. Before writing the script. But make sure they are good graphics: nothing spoils a presentation so much as a visual cliché.THE A Z OF MEDICAL WRITING – • Prepositions that shouldn’t be there. like comprise. And how you will judge your success. They are very powerful and audiences are now becoming used to seeing them. There are some words. • Start and end with a bang. will be available? • How will you judge your success? A round of applause? Immediate promotion? The promise of a contract? Build in some measure by which you can judge your performance. or columns of endless figures written in purple ink and flashed up on the screen for about six seconds. You will almost certainly run out of time. Edit 100 . Limit the words on your slides and make sure that they are in large enough type to be seen from the back of the room. and how will they be seated? What technical facilities. badly presented with long lists of tiny type.

Sometimes it is the fault of the journalist. Press releases These are the tools by which non-journalists can submit news stories to newspapers and thereby place their own messages in the public domain. but to get a story published. Writing a press release is a completely different skill from writing a scientific paper. Many press releases go down well within the organization that produces them. for instance. The object of the exercise is not to please your boss or colleagues. press releases can go horribly wrong. Most go straight into the bin. The tentative findings of a small sample study.PRESENTATIONS your figures drastically: people do not have time to look at columns of numbers. for no charge. Phrases like ‘using written communication techniques to modify the public health in a positive manner’ will be turned into ‘writing to improve public health’. • Use an appropriate style. the journalist will. have the courage not to waste any more of anybody’s time. When it comes to the actual presentation. • Write the press release for the journalist. otherwise you risk sending the journalist off on another story altogether. don’t just ask ‘Do we want to tell people about this?’ but add the question ‘Will anyone be interested?’ If the answer is ‘no’. but on other occasions it is clearly the fault of the writer. Newspapers use a much different language from the one you are used to (see readability tests). Use a strong first sentence (see inverted triangle). Journalists receive dozens of press releases every day – far more than they have room to print. They are potentially extremely powerful (see tabloids). If you want a chance of being published. but clearly have nothing of interest to the publication’s readers (see false feedback loop). Then make sure that the rest of the press release deals only with information relating to that message. Include information only that is strictly relevant. bear in mind that all the careful preparation in the world is useless if the equipment fails. • State the message clearly in your first paragraph. Write five or six paragraphs of two to three short sentences each: if the journalist wants more then they will contact you. will end up in the newspapers as a miracle cure – or a reminder to improve hygiene in the kitchen becomes an impending epidemic of killer bugs. Here are some key principles. who has been overzealous or misunderstood. If you do not translate. 101 . However. • Make sure you have something interesting to say.

• Organization: identify the information you could include. Resist the temptation to start writing too soon (see premature expostulation). jot down the basics of your brief (see brief setting). you need to 102 .THE A Z OF MEDICAL WRITING – • Use official notepaper. You can combine your rumination with other things. The purpose is to get some free publicity. Identify clearly that it is a press release from a reputable organization. At the end of the text put a contact telephone number. few books tell them how to get there. You do not need to be facing a blank screen or empty piece of paper. Writing often fails because we have no clear idea what we are doing. This is better done before we start writing. get someone to say it on the record (see quote). Once you know what you could say to support your message. Yet how we approach our writing has a fundamental effect on how it turns out. Putting things down on paper is easy. the difficult bit is knowing which bits to put down and in which order. Make sure that it sounds like speech: nobody says things such as ‘This is a significant addition to the organizational interface’ (or if they do you should not spread it around). like walking. instead. Process of writing There are dozens of books telling aspiring writers what a piece of writing should look like after they have finished with it. If you wish to include a value judgement. I believe there are five distinct phases. If your story is published. and there are useful techniques (see branching) that can help us. for whom and why. Use double spacing. Do not be put off by the inevitable criticism from those with other interests (see false feedback loop). and make sure that someone will be there when the phone rings. • Remain focused on what you are trying to do. If you feel you must provide complicated background information. • Planning: write down the key points that you wish to make. We therefore need a stage during which we formulate our argument and collect our information. then you have succeeded. This is why it is helpful to spend some rumination time at the start working out the answers to these questions. print this separately on a sheet headed ‘Notes to Editor’. Value laden words – ‘We are pleased to announce the appointment of an excellent new director of public health who comes to us with a distinguished record of service’ – will be destroyed one way or another. • Preparation: take time to define the task. or cycling or cooking. • Avoid propaganda.

by Henrietta Anne Klauser. by Tony Buzan. by Jon Winokur. BOOKLIST: the process of writing • Writing on both sides of the brain. as pioneered by Tony Buzan. is one of the most developed. This book will explain how to do it. and that time spent on this stage does not spell failure One final point: we are all different. is the end product (see effective writing).PROCESS OF WRITING choose what you have room for – and how to order it. • Writing: make the most of your creativity during the first draft. • Advice to writers. encouraging creativity and suppressing the urge to stem the flow. • The mindmap book. and can reach the same goal in different ways. Keep this very short: this is not a first draft but a route map that will help you on your way. to fiddle with the style or check the details of a difficult reference (see free writing). New York: Pantheon Books. 1987. New York: HarperCollins. seeking to block off large periods of time. A splendidly diverting and informative book. The important thing to bear in mind is that this is an essential part of the process. 103 . making sure that it works on all major levels (see macro-editing) and that the details are also thoroughly checked (see micro-editing). entertain and challenge. There are all kinds of non-linear creative thinking. and that anyone who does it differently is doing it ‘wrong’. but a stimulating look at the creative aspects of writing. A little gushing. during which they sit and suffer and write painfully a few hundred words (see writer’s block). and the technique of mindmapping. 1993. What counts. from one-liners to longer pieces. that are written by writers on writing. She discusses some valuable techniques. Many people make too much of this part of the process. This means choosing an appropriate structure for your piece of writing. working in short periods of 15 minutes or so. But this is your chance to be creative not critical. when we work on our first draft. like free writing. 1999. This is a vital period. and then writing a simple plan outlining what each paragraph will deal with. They will instruct. It would be quite wrong to say that there is only one process. • Rewriting: invest time in improving what you have written. after all. and writers should let themselves go at this point. The author has chosen a wide range of comments. London: BBC Books.

as in an early draft of this section. Most important of all. What you should be looking for are basic errors. Project management Proofreading This is the task of reading a piece of writing that is about to be published. cherish them. See also negotiating changes. while there were actually four!). If possible. and any attempts to overturn previous technical editing will be distracting and dangerous – risking more serious mistakes. enlist the help of other readers: a fresh pair of eyes is far more likely to spot errors that you put there in the first place. literally do not add up). such as leaving out the ‘not’ in ‘not indicated’ or moving the decimal point on the recommended dose. Some people are better than others at proofreading: if you do find someone good at the task. It does not follow that they are doing it in the most effective way (see false feedback loop). Make your corrections clearly in the text. so that you do not become distracted by the meaning. Find yourself a quiet corner so that you can give the proof your full attention. Propaganda 104 A derogatory term used to dismiss a piece of writing that we believe upholds a viewpoint with which we do not . Writing is not one task but many.e. It is too late for that. send the proof back in time for the deadline.THE A Z OF MEDICAL WRITING – Professors They will usually have done quite a bit of writing. Some say that you should read each proof twice. which urged readers to ‘watch particularly for three types’. and • nasty remarks about other people that could land you in a court of law (see defamation). and identifying any errors that may have crept in during the writing and editing processes. • anything that could kill. Major pieces of work will need careful planning (see time management). • numbers that are inconsistent within the copy (i. The mistake that authors sometimes make is believing this is an opportunity for them to improve what they have written. Watch particularly for four types: • misspellings of names of people or their titles. Others recommend reading backwards. once for major errors and another for minor ones of spelling and punctuation.

we lose sight of the audience. Publicity It is probably an exaggeration to say it is always good. Institutions and individuals would also benefit from this approach.’ Cover it up. to help us adjust to our audience and put our message across. When we write. 105 . newspaper. magazine or journal will be published. But it is usually less bad than many people think (see false feedback loop).PROPAGANDA agree. (Writing that upholds viewpoints with which we do agree. and summoning extra staff to help with the distribution. Publication planning Many pharmaceutical organizations now spend time and money working out what papers they need to have published where and by when. and ask what it means. You (and they) may well be astonished by the clarity of the reply: ‘We need to consult with our partners. Pub test A useful and simple concept. apply the pub test: how would you have explained this to your target reader. all kinds of other arrangements have to be made. we tend to consider fine writing. face to face? This invariably produces a sentence that is simpler and easier to understand.’ Publication date The day on which a book.) All writing has some kind of bias. such as reserving time on the printing press. Once this has been agreed. such as eye contact and stifled yawns. so we should not worry too much if others dismiss what we write as propaganda – provided that there are other outlets for them to express their points of view and that we have not done it too obviously (see Pravda effect). and spend large amounts of time putting on (an unnecessary) posh overcoat. Whenever you come across a particularly impenetrable piece of prose that you have written. Read the offending passage to them: ‘The strategy has been designed to dovetail with the strategic planning processes of the main partners. which is why we need deadlines. When we speak we make use of a wide range of visual cues. Postponing these arrangements is tiresome and costly. The test is useful when helping others with their writing.

‘Please turn off the light’. Beware overuse: The write stuff (as a headline on articles about writing courses) has become a tedious cliché. quotation marks. are well read and acted upon. hyphens. dashes. But these articles are often badly written and hard to read. few take-home messages seem to get through (see CF Kellett et al. 106 . commas. So we can go to enormous lengths to make an understandable spoken sentence. The sentence or phrase should work with both meanings. On these occasions you should write to impress (see political writing). which leaves the clear implication that we need to put our messages out simply. In fact the evidence of market research (and commercial success) shows that these publications. 1996). doctors unite in their condemnation of medical newspapers.THE A Z OF MEDICAL WRITING – Pulse paradox Doctors have been led to believe that the type of writing to which they should aspire is the type of writing they see in medical journals. Puns Using a word with two meanings and making people smile (or even laugh a little).’ Unfortunately this kind of writing usually ends up being incomprehensible. At the same time. Lancet August 17. Punctuation Marks that make our writing easier to read (see colons. but do not expect readers to act on what you have written (see Pulse paradox). full stops. exclamation marks. and it can take years for findings to be translated into action. or follow the style of the medical newspaper. into gobbledegook: ‘It is recommended that the overhead illumination be forthwith terminated. Poor recall performance of journal-browsing doctors. This leaves anyone writing for doctors having to choose: do they follow the style of the journal. There are clear exceptions – when writing for doctors who believe that writing is of value only when they have to struggle over its meaning. which are written in simpler English. and risk being ignored. without fuss (see pub test). semicolons). which they dismiss as ‘comics’ or ‘funnies’. and risk being undervalued? It’s rarely an easy choice. Putting on the posh overcoat It is hard to escape the feeling that when we write we need to impress (see English teachers).

’ Quotes can sometimes be controversial. but what exactly is it (see effective writing)? Questions Starting with a question is a risky way of arousing interest. who has all the characteristics we need. and read no further. Doubtless some do. Unfortunately. if you don’t do it. ‘Do you want to be rich and famous?’). Be determined in putting them across: listen to how politicians manipulate (or even ignore) the 107 . and what they really are trying to achieve.’ If someone asks you for a quote. write down two or three key points you want to make. For all questions (even. many people don’t remember what they have said. If you go ahead.QUALITY Quality We all want our writing to have it. or put one in the title or headline. Interviewees favour them. only start with a question. All you need is the odd 10–15 minutes and some sensible deadlines. Consider whether you want to take part. and change sensible statements like ‘It seems hot’ to ‘There is evidence of an elevated temperature. but the majority will not. Find out what they want you to talk about. readers tend to switch off. someone else will – perhaps not so well.” said a spokesperson for the human resources department.’ The function of the quote is to allow for comment or vividness: ‘“It is a vitally important job and we are so lucky to have Mr Smith. some will immediately answer ‘No’. don’t be flattered and accept immediately. As a general principle. with some people believing that journalists always make them up. because it gives them control. Questions and answers A dreary way to write up an interview. however. The function of the main part of the text is to relate independently verifiable facts: ‘The new job will involve counting every paper clip in the hospital. So why not start now? Quotes Quotes are an important part of news stories. Quiet You do not need to put aside large tracts of time in order to write. while others get cold feet. if it is clearly the policy of your target publication to do so (see evidence-based writing). who the audience will be.

much loved by pedants. Quotation marks Quotations See copyright. If not. “I shall be boarding The African Queen”. Speak simply. Quotation dropping The practice of looking in a dictionary to find a quotation that can be plausibly put into the text in an attempt to show that the author is erudite. use the other one for quotes within quotes: ‘“In a moment. either as a written note or.’ There is a tiresome point. and don’t volunteer too much. Adds little to the argument and is usually less a sign of erudition than that the author has access to a dictionary of quotations.” he said. so follow the style of your target publication (see evidence-based writing). Whichever one is favoured. more usually nowadays. If this is the kind of thing that turns you on. 108 . Avoid putting single words that you think are slightly vulgar (‘tummy’. if they do know it. be robust when others tell you that they wouldn’t have done it that way (see false feedback loop). If you are writing for a magazine or a newspaper then you may well want to use quotes from others. refer to the grammar booklist. use it without making excuses. Make sure you have an accurate record. of where precisely to place the full stop when using quotation marks. Some publishers prefer double marks and others prefer single ones. on tape. put the full stop where you think it fits and let others sort it out. for instance) into quotation marks. If your audience doesn’t know the word don’t use it. Store these records for several years. When it is all over.THE A Z OF MEDICAL WRITING – questions in order to give the ‘answers’ they have prepared.

RACISM

Racism

See political correctness.

Readability scores

These grew out of attempts to measure how good we are at reading. They were first developed as ‘reading ages’ in the 1940s, but later lost their appeal – only to be saved by the emerging software industry which took several of these tests (such as the Gunning Fog and Flesch) and added them to word processing packages. They are entertaining and useful, though we shouldn’t expect too much from them. The Gunning Fog index, for instance, rests on the assumption that the longer the words and sentences the harder a piece will be to read. This seems plausible enough, though it leaves out a number of other variables, such as motivation and cultural background. Being numerical, it has a spurious air of scientific accuracy, and while a high score is associated with difficult writing, it does not necessarily predict it. Writing to keep the index number low will not in itself guarantee that something is readable. That said, the tests can make an excellent market research tool that enables writers to test whether what they have written broadly speaking matches the tone that they are trying to achieve (see evidence-based writing). They can also show, when others try to change our work, whether they are taking it nearer to the style of their target audience, or moving it further away. Finally, readability scores encourage us to look at what we are writing in terms of how it will be understood – rather than whether we are meeting the rules of grammar and style – which must be a good thing.

Readers These are what the writing business is all about. Without them we are wasting our time. So, to anyone reading this, thank you for bothering. Readers’ advocate One of the most important tasks of the writer is to uphold the interests of the true target reader (see false feedback loop; negotiating changes). Reading
effectively. 109 An essential activity for those who want to write

THE A Z OF MEDICAL WRITING

Record keeping

It is prudent to assume that someone some day will challenge the facts that you have cited in your writing. Be prepared. Take good records of all you do – and keep them for several years. If you were challenged in a court of law, how would you fare?

Redundant words Refereeing

See flabby phrases.

See peer review; tautology.

References When writing for scientific publications (but not for magazines or newspapers), authors are required to give the source of any information or opinion that they cite, at the end of the text. These are the references, which are highly visible, make everything checkable and thereby, it is widely assumed, elevate the whole business of writing from anecdote and opinion into fact. It takes up a lot of time, not only in reading, sorting and selecting, but also in negotiating which of each co-author’s favourite studies should be included, and which others should be deleted. Authors can get bogged down with chasing and discussing references (see writer’s block) sometimes at the expense of more important matters, such as whether the message is clear, or they are submitting to the right journal (see brief setting). There is also a danger that the system as it now stands gives the illusion that science writing is more objective than it is. Often the references cannot be traced back and, when they are, the authors are clearly saying something completely different. In one famous study only about one reference in three was without error (George PM and Robbins K [1994]. Reference accuracy in the dermatologic literature. J Am Acad Dermatol 31(i): 61–64). Bias creeps in because of the widespread use of the reference as an indicator of the worth of journals (see citation index). In order to keep their place in the league tables, wise editors make sure that articles from their own journals are quoted. As for individual writers, they should consider the following principles. • Use the references to support what you have written. Write first; add the references later. Do not write by collecting references into piles and then stringing them together into some kind of order (see leaf shuffling). By all means immerse yourself in the
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literature before you start to write, but during the process of writing make sure that references are kept out of sight. Add them during the rewriting. Make sure you read every reference yourself. This is an area where you do need to invest time. As the author you are responsible for ensuring that the references you cite are accurate, and this means reading them in the original as well as tracking them back to their first appearance. Be obsessive about this. It is unlikely that anyone important will check them, but there is an important matter of principle: how much value can we put on a system that prizes itself on its integrity when a major part is full of inaccuracies? Follow the house style. Read carefully what the Instructions to Authors says, and look at how references are handled by your target journal. Follow that style to the letter. You may be given the choice of using Vancouver or Harvard style. Ask your publishers to explain these if you are unsure. This will not only help you to create the right impression with the journal’s staff, but it will also free them to spend time on more useful things, such as sorting out impenetrable sentences and double-checking the figures. Use electronic reference managing systems. It is now possible to buy software that will insert and arrange your references and put them into your target journal’s style. This can save a large amount of time. However, don’t use the ease of assembly afforded by these systems as an excuse for not reading the references. Don’t be shy about using references tactically. Favour articles that have been published in your target journal. This will please the editors. It will also show that you are taking part in a continuing discussion that has been going on in its pages. If you are nominating reviewers, make sure that their work is cited. Don’t get obsessed with references. If the editor or the reviewer disagrees with your choice, then you can remedy that easily. This is providing supporting information; it is not a public examination (see false feedback loop).

Rejection This refers not to a general feeling of inadequacy (it’s not really that kind of book), but to those specific and deeply memorable occasions when we submit a piece of writing, and it is sent back to us with a ‘Thanks, but no thanks.’ The first thing to do is to grieve. Feel inadequate (though put a deadline on this). Go for a long walk. Otherwise do nothing that you might regret later. When you have calmed down, learn from what
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respect the principle that the editor’s decision is final. There is a good chance you will be able to get the work published elsewhere. With academic publications. forced to the conclusion that publication isn’t really a priority for us under present circumstances. and how much you are learning from the experience. as with the editors of magazines and newspapers. such as having a similar story already in the pipeline. You have failed to ‘sell’ your product. if you believe that your article has been turned down because the reviewer has made an error and given bad advice. you will have the reviewer’s reports to sift through. so try to work out why the customer declined. However. and it will be immediately reversed. But generally you will receive a bland and polite statement: ‘I read your article with great interest. you will rarely have the luxury of detailed feedback. If you are writing for magazines and newspapers. If the editor says that you are right but it’s still not being published. The preferred option. sadly. Another tempting option: all you have to do is write an eloquent letter showing the editor why the decision was wrong. With magazines and newspapers this will get you nowhere: their editors will take the view that they don’t advise you on surgery so they don’t expect you to advise them on editing. Make sure you work out the real reason for the rejection. It is always tempting to do this. so examine the rejection letter carefully. Persevere. or a judgement that the topic has run its course. or feel a failure.THE A Z OF MEDICAL WRITING – you have done.’ If you are writing for academic publications. • Throw the article away and try to forget the whole experience. you must respect that decision (see fairness). Don’t blame others. • Submit the article to another publication. with facts not emotion. however. painful though it may be. Under no circumstances should you just blank out the name of the first editor and send it off to another. but consider how much work you have already done. If the editor says that publication of your paper is not a priority then. but I am. there is the chance of appeal in certain circumstances. Do so politely. The editor may have given you a clear reason. Find a new market and 112 . then you should consider an appeal. • Appeal against the decision. Was it for technical inadequacies (in which case you should be able to take remedial action) or was it because the editor had other articles that he thought were more suitable for the readership (in which case you need to think of an alternative customer)? Rejection requires one of three possible actions.

be clear in your mind how you will judge success (see effective writing). Generally these will review a situation (or problem). or offensive to public taste – and you cannot (or will not) do anything about it. current situation/problem. Examples might include introduction. the greater the chances of your report being successful (see marketing). This is the time to hold a ceremonial burning – and get on with your life.REJECTION research it (see evidence-based writing). sadly. Look at the reports that have worked before for your audience. you have a powerful tool. occasionally you will write the article that no one will ever accept. Most people receive rejection letters. once you master the technique. discussion. and follow the style of the 113 . And it does make that acceptance letter – when it comes – that much more worth while (see acceptance). recommendations. and then put some recommendations. Here are some tips. Whom do you want to persuade that you have done a good job? Who will make the decision to give you more equipment or change policy? Who are the opinion leaders you need to reach? The more focused you are. analyse it. The logical time to give up is when editors and reviewers continue to make the same objection – insufficient numbers in the sample. Look at your message: is it right for that market or do you need to adjust it slightly? Go back to the start of the process (see brief setting). Are you reporting last year’s activities. When do you give up? Although most rejected articles are subsequently published somewhere. Work out what you want to achieve. like closing down a hospital? Whatever you decide. for instance. these are pointless. or to persuade people to take drastic action. While unpleasant at the time. or to change an existing policy? Are you writing to raise awareness of an issue. • Decide why you are writing the report. Some reports. • Sketch out the main sections you will use. they are good for the soul and better for the writing. in which case what impression do you want to give? Are you writing to obtain an extra piece of equipment or new member of staff. background/history. Reports All professional people have to write reports. It will probably take less time than you imagine. and will be more effective than just tinkering with the rejected version. This is a specialized type of writing. are written only because someone has been told to write them. • Decide on the real audience.

Some documents run into trouble because they have to appeal. Cultivate a simple style – and keep positive. by Elaine Kempson and Nick Moore. Thus: ‘This report looks at a new cure for writer’s block which. Research All types of writing – not just science writing – will fail if the research is inadequate (see bad writing). BOOKLIST: research into writing • Designing public documents: a review of research. Don’t mix too many type faces (see polyfontophilia) and avoid strings of capitals and long sections of italics. write two reports. say. Readers find it hard to unravel complex sentences. These tend to work better if there is a verb in them. will ensure that our publication rate will treble’ (see first six words test). • Word choice. and use the executive summary as your selling tool for the decision makers. Many readers’ problems are caused by unfamiliar words. to an audience of professional colleagues who have one set of expectations (see jargon). • Use the introduction to motivate the target reader. • Signposting. you should have a type size of 12 point. London: Policy Studies Institute. The most important factor is that the type is large enough.’ tell the reader what is in it for him or her.THE A Z OF MEDICAL WRITING – successful ones. Approach each section as if it were a separate piece of writing (see process of writing). • Typefaces. ‘This report looks at a new cure for writer’s block. if introduced to this department. for instance. Here is a short selection of some of the main findings: • Long sentences. Research into writing Even those steeped in the harshest traditions of evidence-based medicine can become remarkably cavalier when it comes to making decisions about their writing. while at the same time having to convince the non-professionals who will make the decisions. Readers find it helpful to have plenty of headings and subheadings. For going across an A4 page. Making sure that the verb appears early will help. foreign words and negatives. Fortunately there is a solution: write the report for your professional peers. both from psychological experiments into readability and from market research carried out privately for commercial publishers. But a wide range of evidence exists. Instead of writing. 114 . • If necessary.

Retractions Be careful about these. Say what you want to say. with details of many of the experiments on which this advice is based. This classic ranges over typography and layout. This function is increasingly served by signed editorials. look carefully at other review articles that have already appeared in that journal (see evidence-based writing). • Designing instructional text.RESEARCH INTO WRITING 1994. It begs the question: why did you say it in the first place? Distinguish from corrections. illustrations and tables. Ask for an example of the type of review article the editor has liked. If you are asked to do so. Do not store on computers at work. Traditionally they gave authors the chance to ‘review’ what was known on a topic. We also have systematic reviews. and in what form. Resignation letters These can be wonderfully liberating to do. but these are written in the form of scientific papers and the term really refers to a research technique rather than a type of writing. and drawing conclusions. especially when you are deeply unhappy. develop an 115 Review articles . don’t mince words. Useful advice for those designing forms and other documents. Generally authors will be invited to write review articles. Make sure you have in writing what the editor wants you to do – the precise topic. which involved assessing the information available. deadline for the article and other relevant conditions (such as will you get paid?). go on to set up the question they are to address. You will also need to know such details as length. 1994. London: Kogan Page. Look in particular at the structure: most review articles (though not systematic reviews) move away from the traditional IMRAD structure and follow the structure for editorials and feature articles. In general they start off with a first sentence that should attract attention. degree of original statistical analysis required. They mean that you wish to take back an opinion you had earlier given. effective writing and evaluating design. charts or tables. then put the letter away – at home. organizing it into a coherent structure. by James Hartley (3rd edition).

at least. Go through the normal stages (see process of writing). come to rest with the message. ask the macro-editing questions. though if all goes well you can have another celebration later (see effective writing. Don’t rush into it: you will need to put some time between the first draft and this stage – preferably leaving it overnight. payoff). The big problem for most people. though not necessarily all at once. such as is the message still there. What happens later is. Sometimes the number will depend on the importance of the writing – a thesis will usually receive more attention than a letter home. however. you can start looking at the micro-editing issues – checking facts. Take time to review the material available before starting to write. beyond your control. and come to some kind of plausible conclusion. Rewriting This is a vital part of the process of writing. which is to use your knowledge and skill to look at a topic. First. When you come back to the draft you will need to look at it in a number of ways. It is not the Gospel. accuracy. Insufficiently used when it comes to writing. Printing out each 116 . Be realistic about what you have been asked to do. at the end of the article. For major tasks (such as a thesis or a scientific paper) make sure that you celebrate as soon as you have finished. is knowing when to stop rewriting: this is where deadlines are invaluable. grammar and style. Reviews of books Rewards See book reviews. but it is unhelpful to concentrate all your resources on them. Once you have carried out these tests. How many drafts should you do? There is no easy answer. bring together the information you have found. Sometimes it will depend on how well you have planned the writing. is it in the appropriate place and is it still right for the audience (see setting the brief)? Also ask if the structure works (try the yellow marker test) and whether the tone is appropriate? You will probably be surprised at how well you are doing so far. to some extent. It is important to get these right.THE A Z OF MEDICAL WRITING – argument that addresses it (one step per paragraph) and finally. These are the big issues.

If you find. My advice to writers is to approach the matter from a different direction entirely. You can do this while doing other things. define the message you want to give and match it to a journal (see brief setting). it suggests that your writing is about to be successful (see effective writing). Don’t worry unduly if you don’t seem to be making progress. Editors take the view that the role of scientific publishing is to record and validate science. the role of scientific publishing is to validate themselves and their careers. that you have enough unused material that would support a different message suitable for another journal. from the writer’s point of view. Salami publication The practice of undertaking one piece of research and then cutting slices off it for publishing in various journals. 117 . by enabling them to rack up points with each publication. and therefore there is no reason to slice large studies into smaller bits. Some people feel that rewriting represent failure. So the more publications the better. Rubbish Rumination There’s a lot of it about (see brief setting. then go ahead and write it. using the data needed to support the message. But set a deadline because at some point you will need to put something down on paper (see brief setting). Once you have collected the data. such as riding a bicycle.REWRITING edition as you revise will help to remind you that you are progressing a piece of writing and not just fiddling on a computer. on the contrary. It is currently frowned upon by the editorial establishment. having written this article. The period at the start of the process of writing where you let the ideas go around in your head. Then write your article. But. lying in bed or taking a bus. crap).

There is no justification for them in any kind of writing. therefore. consider the work as a whole. making a product and then selling it in that market. For many doctors and scientists they are the most important bits of writing that they do. Often the starting point for a paper is the request to put a mass of data into some kind of order. because the task then becomes more manageable.g. and there is now a widespread belief that the tradition of trusting other gentleman scientists is no longer enough. there has been a steady stream of cases over the last few decades. Instead of immediately allocating bits of it to the four sections (e. Scientific fraud A posh term for lies. details of the data collection into the Methods section). Scientific papers contain original research. by implication. The question ‘What makes a good paper?’ is much harder to answer than ‘What gets a paper published?’ I therefore advise focusing on the latter (see evidence-based writing). Academic institutions. are vastly inferior. They earn their authors valuable credits. Certainly it can be seen as any other transaction that requires researching a market. Meeting the following points should increase the chances of your article being accepted for publication. the 118 Scientific papers . • Have one simple message to put across. They follow a specific formula (see IMRAD structure) and a particular style. Editors are sensitive to the problem. Such cases tend to rock the scientific community. Writers should adopt the following principle: do not at any time put your name to a paper unless you are sure that everything in it is true – and that you could prove it if necessary in front of lawyers. are beginning to realize that they need to adopt explicit procedures if the integrity of researchers is to be accepted. Ruminate. on a topic that is new and important. There is no evidence for this belief (see gravitas). Then set the brief. and to the dangers of being required to spend more and more time policing science rather than communicating it. which they use for climbing up the career ladder or amassing more funds for their department.THE A Z OF MEDICAL WRITING – Science writing A term used by scientists to distinguish what they write from other types of writing which. ranging from the slight (but nevertheless dishonest) massaging of figures to the lengthy discussion of patients that never existed. However.

Polish up the presentation of your figures and tables. Supply outstrips demand and your article may be rejected. You can do all this later. Yet many feel that they should now subject the draft to a barrage of detailed criticism. This is a dangerous time. on the 119 . The hard part of writing is not putting in information but deciding what to leave out. This produces demotivated authors and dreary. or copy down the precise details of a key reference. and write the additional items you will need – the title.SCIENTIFIC PAPERS • • • • • • first part of which involves formulating a one-sentence message for your work. It will be a great help at this stage if you have already agreed the market and message with your co-authors. Handle your co-authors carefully – but firmly. If you have done your work well you will have a product that will meet the needs of your target journal. Send off the package. If so. There seems to be a feeling that a paper that starts out suitable only for a minor specialist journal can somehow be improved by detailed criticism (see Icarus fallacy) so that finally it will be accepted by a major international journal. Keep your nerve: your job is to keep the article on track for publication (see negotiating changes). disconnected prose. the abstract. check a matter of detail with your records. and start (see free writing). Decide in advance where you want the article to be published. Never interrupt your flow – whether it be to go back and fiddle with the sentence you have just written. If. You can and should decide. doing one section at a time. Write each section in one go. The advantage of this is that it also identifies what is not relevant. inching forward painfully. which journal will be most suitable (see marketing). before setting out to write. and make the writing itself much easier (see evidence-based writing). Agree this with your coauthors before you start to write. I therefore recommend some kind of brain storming (see branching) that will encourage you to select information that supports the message you have chosen. Take your plan. most of which will concern minor matters. Now you can start to work on the details. Polish the draft and add the extra items. This will save time. Many writers spend long and unhappy hours at a word processor. but be careful not to neglect macro-editing. This is not so. the references and the covering letter. find a quiet spot for 15 minutes or so. increase your chances of getting accepted. don’t just throw it away (see rejection). Follow the Instructions to Authors. Collect information to support the message you have chosen.

by Robert A Day. Keep everything in perspective. by Tim Albert. your paper is accepted (as it should be if you have targeted it correctly) don’t forget to celebrate. by Jane Fraser. such as ‘approximately’ (instead of ‘about’). Scientific words Some words are truly scientific. 1989. One of the few books on this topic that is genuinely funny. 1996.. 1997. 2000. The fact that you can write a scientific paper shows that you can write a scientific paper. such as ‘tyrosine’. • Publishing your medical research paper. Includes some useful chapters on the changes brought by electronic publishing. Baltimore: Williams and Wilkins.THE A Z OF MEDICAL WRITING – other hand. by William F Whimster. • Biomedical research. ‘autosomal dominant transmission’ or ‘multivariate logistic regression’. Five hundred tips for success from an author who comes from the UK (as opposed to US) tradition of science writing. in that they describe precise things or concepts. even when writing scientific papers. publishing and presenting research. 1998. Abingdon: Radcliffe Medical Press. don’t use them 120 . It does not predict your performance as a doctor or your worth as a human being. It is written from the US perspective and has some interesting data about what reviewers think. Modesty forbids . This book promises ‘over 200 expert tips’. Cambridge: Cambridge University Press. • How to write and publish a scientific paper (3rd edition). but this book takes the line that writing scientific papers is not as hard as many people make out. A broad sweep through many aspects of planning. by Daniel W Byrne. Other words. It goes through the process in 10 easy stages. Semicolons (see full stops). Abingdon: Radcliffe Medical Press. Avoid them. London: Springer. BOOKLIST: scientific papers • Winning the publications game (2nd edition). ‘elevated’ (instead of ‘raised’) and ‘demonstrated’ (instead of ‘showed’) are merely pompous words. • How to publish in biomedicine. If you are having to look this up..

first sentence. The reverse will usually be true. A defamation which is spoken (as opposed to libel. simple and active.’ Or this: ‘To ensure that evidence from systematic reviews informs clinical practice in district general hospitals.SENTENCES Sentences Keep them short. Do not assume that they take less time than long articles. topic sentence. such as wall posters or practice guidelines. Spacing after a full stop Many who trained as typists on mechanical typewriters were instructed to leave two spaces after the full stop. Keep out subsidiary clauses and phrases. which include some early surprises. Sexist language Short articles See political correctness. Put the verbs in early. we believe that those professionals who lead clinical departments should appreciate evidence-based medicine and how to incorporate review evidence into effective implementation methods to influence their staff.’ See also final sentence. There is a better way (see setting the brief). otherwise you will end up with something like this: ‘These results. on the effects of treatments and risk factors in determining trends in coronary heart attack rates and mortality. although further analyses remain to be done. Shuffling data around One of the main preoccupations of those writing scientific papers. which is written). 121 . will create considerable discussion and controversy amongst the world’s experts. Word processors are more flexible when it comes to spacing. Simplicity Slander A virtue in writing. and now the convention is to have one space only.

THE A Z OF MEDICAL WRITING – This gives rise to all kinds of difficulties. ophthalmology. This practice causes some people to get upset. and do not tell us if we have a good word in the wrong place. ‘piss the buck’ and ‘subsequent grips from rivals’). most modern authorities say. I came across ‘a strong of nouns’. ignorant and no longer a rival for the next job (see politics of writing). separate. seem to agree that this rule is based on Latin grammar and was misguided from the start. inoculate. Most scientific journals now take statistics very seriously. I don’t necessarily mean the classics: airport novels. You then need a good dictionary. they tell us only that we have a properly spelt word. as in (and now famously) ‘to boldly go’ rather than ‘to go boldly’. then go ahead and split it. occurred. One of the best ways of improving your spelling is to read clear English. If you want to split an infinitive and it sounds right. We need to take this into account when writing for journals and involve a statistician at an early stage. and there is no excuse for not switching them on. with professional statisticians advising them at the highest level. unnecessary. (While revising early drafts of this book. newspapers and magazines are quite good enough for this purpose. ‘collecting the date’. Get them right and you are already doing better than others: accommodation. Meanwhile. However. Computerized spelling checks do help. Spelling Split infinitives This is where the two parts of the ‘infinitive’ form of a verb are split by an adverb. however. pass them a reference book and challenge them to find support for their position. corollary. and the energy and self discipline to use it. for instance. because alarm bells will start to ring when you see an aberration. here are 10 commonly misspelt words (UK version). resuscitate. All writers on style. Starting Statisticians See getting started. publicly. mainly because people love finding other people’s spelling mistakes and using them to imply that they are uneducated. You need to be familiar with the shape of words. If anyone complains. One of the problems is that English spelling has few rules. and those that do exist have exceptions. Establish before you start 122 . diarrhoea.

are vague and unmeasurable. concise. A common proofreading mark which means – ignore the ‘correction’. Structure It is easy to get so caught up in the meaning of a piece of writing that we take for granted the way the writing has been constructed – in other words the structure. sentences)? Should the message be at the start. and in life. Stet Latin for ‘let it stand’. Stereotyping In writing. not to drown it (see leaf shuffling). They sound good but. flowing. alas. Use statistics to support the message. a great evil. They do not give us anything concrete with 123 . Co-author with EB White of an excellent book on style (see style booklist). and they will come up with a number of requirements. titles)? The structure to use is the one that your target audience likes and knows (see evidence-based writing). and then report accurately. His name was adopted by the staff of the late lamented magazine World Medicine to describe the process by which a piece of incomprehensible pomposity was elevated into crisp prose by the skilful editorial staff: ‘That was most sensitively strunked’. such as clear. Structured abstract Strunk See abstract. But keep a sense of proportion. Variables are likely to include: how long will the piece of writing be (length)? How will it be organized (paragraphs. Listen. Endless statistics can impede communications. or buried at the end (inverted triangle)? Will it follow the scientific IMRAD structure? How will it be labelled (headlines. elegant. etc. Unfortunately much modern science writing has become a succession of statistics that only the statistician and his mate understand. Style (1) Ask a group of people to describe a ‘good writing style’.STATISTICIANS whether you will have enough numbers from which to draw any meaningful conclusions.

1979. in this competitive world. London and Basingstoke: Picador.’ Some writers also feel that style is a mark of personality – that writing is a chance for us to show what we are like and. A splendid attack on the pomposity of medical writing with some excellent examples and some sensible advice. Forget literature. Over the past 100 years or so writers have generally agreed about how to make this kind of writing work. And ask why science writing is so different. you will see all of the above ‘rules’ broken constantly. At least this gives us a yardstick with which to measure style. a scientific paper in The Lancet. 1997. but they do not tell the whole story. BOOKLIST: style • The elements of style (3rd edition). say. by Strunk and White. 1989. they allow those who write badly to justify almost anything they have written: ‘I think it’s elegant! And it flows. The bible. short and simple sentences. These include the following elements: logically developing paragraphs. positive statements and sensible word choice. In other words. but this book is not about winning a place among English literature classics. 124 . Trenchant views on writing from a distinguished playwright and journalist. by Keith Waterhouse. When it comes to those endless discussions with co-authors or bosses. we have to show off our skills. It is about the craft of putting together words in such a way as to enable you to put messages across to a target audience. for simple effective writing. If you look at. it gives an easy solution: allow any changes that are likely to improve the chances of putting the message across to the target reader. active voice. • The Picador book of sports writing. They are all good tips. • Waterhouse on newspaper style. 1996. If you are planning to write a book that will win a literary prize then that view might be sustainable.THE A Z OF MEDICAL WRITING – which to judge. Cambridge: Cambridge University Press. style is not writer-related but reader-related. • Medical writing: a prescription for clarity (2nd edition). Worse. So what then is an effective style? I favour a relativistic approach: a ‘good’ style is the way a writer constructs sentences and chooses words so as to increase the chances of getting the chosen message across to the chosen audience. London: Penguin. by Neville W Goodman and Martin B Edwards. look at how skilled writers describe the games we play. edited by Nick Coleman and Nick Hornby. New York: Macmillan. resist those that will have the opposite effect (see negotiating changes).

London: Orion Books. subeditors play an important part in the business of bringing information out promptly in a reasonably clear and accurate state. See also copy-editors. celebrate. Oxford: Oxford University Press. This gives substance to the view that some kind of rewriting – and preferably by an informed third party – should be an integral part of the writing process (see rewriting). Subeditors Although they can be mocked by the flashy prima donna reporters. Style (2) The set of rules set by a publication to lay down policy in some of the many areas where there are genuine ambiguities (Mr or Mr. or -ise or -ize?). as well as spotting (most of) the worst and most dangerous errors (see lawyers). subeditors are generally experienced readers and writers who can turn turgid self-indulgent prose (see crap) into something approaching clarity and even interest. negotiating over text). for example. A new paperback version of a book originally written for the Sunday Times. Like technical editors. This will defuse those endless and time-wasting rows over matters as unimportant as the use of a capital letter or the exact positioning of a piece of punctuation (see Instructions to Authors. or they should agree on a reference book that they will use instead. The thinking behind this is that readers care little about which version you use. And when you get there. by Martin Cutts.STYLE • The plain English guide. • Put it in writing. ranging from one or two sides of paper up to (as with the Economist) a major book that may be published commercially. All organizations where members spend large amounts of time writing would benefit from a style guide of their own. John Whale. 1999. 1996. An excellent handbook on how to avoid gobbledegook from one of the original leaders of the Plain English campaign. as long as there is consistency. 125 . Essays range from ‘Being understood at once’ to ‘Sparing the readers pain’. Style guides All professional publications will have a style guide. Success Make sure you define how you will define it (see payoff).

and these can be applied to other. Icarus fallacy). the messages in these papers leave a lot to be desired. The journal. See evidence-based writing. Journals will differ in their precise requirements. Millions of people spend huge amounts of money each day to buy them. and you must look at your target journal’s Instructions to Authors before embarking on time-consuming work. Few other pieces of writing are so consistently successful. magazine or newspaper to which you intend to submit an article. the tables should give the information gathered. Similarly. Tabloids Target audience Target publication See audience. but writers ignore them at their peril. They then read them – and go away with the messages that the authors intended. 126 . Tables For scientific papers. catering to the prurient – and meaningless to those who do not regularly tune into popular TV culture. It is fashionable to be dismissive of tabloid newspapers. while the text should provide a reader’s guide to the main implications. They include the assumption that words are worth putting out only if they are read (see effective writing). Admittedly. Systematic reviews See reviews.THE A Z OF MEDICAL WRITING – Summaries See executive summary. the principle of starting with the most important message (see inverted triangle). when writing for any other market. these are inextricably bound up with the text. But they use some excellent techniques. Choose it before you start to write. less controversial messages. liaise with your editor to find out how data should be presented. such as books or magazines. and the practice of using all kinds of devices to attract passing trade (see layout). In essence.

It is very different. turn it into reasonable English and sort out uncertainties with the author.TAUTOLOGY Tautology Saying the same thing twice over. Good technical editors are worth their weight in gold and there is a clear message for medical writers: cherish them. Such people would do well to reflect that technical editors spend all of their days working on scientific manuscripts. Half of them die. who is generally employed by a book publisher. from the work of the editor. Avoid (see absolutes. whose principal task is to decide what goes into the publication. however. as in ‘young child’. science writing has a convention that the past tense should be used for describing what you did and found (‘The rats died when we gave them the poison’) while the present tense should be used for a proven (or generally accepted) fact: ‘Rats die when given the poison’). ‘vision for the future’ or ‘priority for action’. 127 . Unfortunately the egos of many writers prevent them from seeing changes as anything other than a direct challenge to their authority and talents. but the technical editor will be the person who will quietly and with little thanks bring it up to the required standard.’ However. See also verbs. They will spend roughly half a day on each paper: they will check for errors. put the copy into the style of the journal (which gets particularly tricky when it comes to dealing with the references). The editor may make the decision over publishing. less full of internal inconsistencies and less incomprehensible. ‘past history’. Tenses Choose one time frame and stick to it. well. and will know far more about them than they do. The work is similar to the work of the copy-editor. Technical editors The unsung heroes and heroines of science publishing – who spend hours at their desks working on manuscripts that are full of internal inconsistencies and incomprehensible sentences and making them. It is obviously wrong to say: ‘We experimented on 3000 rats. who start from the premise that the writing needs to be marketed and polished as well as checked. It also differs in some ways from that of the newspaper or magazine subeditor. See also author’s editors. flabby phrases).

which is broken. few people seem to know or care nowadays. Thesis writing The bad news is that these are very long. Purists hate it. and try to find out why. • Spend time thinking about what you want to say. but it looks as if it is here to stay (see political correctness). You will need a framework for dividing up the work. The task is not to become an expert on your chosen topic. theses are similar to all other types of writing (see process of writing). The good news is that the person who will be reading it is not only required to do so. neglected (see commissioning). One of the major obstacles to writing a thesis is the feeling that it will be used to judge you. That/which The rule is to use ‘that’ when it is defining or restrictive (‘The bed that is broken must be taken away’ – take the bed away) and ‘which’ for the non-defining non-restrictive (‘The bed. very boring and very important. That apart. as in: ‘If someone claims that they are libelling them’. In fact what people write in their thesis shows how well they can write a thesis. These are sometimes made explicit in instructions to candidates or similar material. so does it really matter? (My copy-editor thinks so. the message that you think you should give. but look also for other variables.THE A Z OF MEDICAL WRITING – Thank you These two words are probably the most powerful tool for improving the quality of writing. 128 . such as length. Work out exactly what the requirements are. but is generally required to look for the positive as much as possible. Then use branching to work from this central idea outwards. That said. personally. so that the large amount of information you are gathering begins to form a pattern. poor argument). must be taken away’ – take the bed away and by the way it happens to be broken). but to produce a long piece of writing that will achieve your goal. but more often candidates have to work them out for themselves. structure and style. formulate. Here is some advice. but then that’s her job!) Them This has now become a singular asexual pronoun. They are. then test. This will help you to avoid leaf shuffling. • Don’t be intimidated. To help you do this. Look at papers that have succeeded and at those that have failed. sadly. In some cases it will be the content (lack of information.

or reading a newspaper as you travel into work? 129 . branching). and fill each one of them up. Work out how and when you are going to find the time to research and write. Make sure they are realistic and achievable. What will you stop doing – watching a TV show.THESIS WRITING • Plan how you are going to spend your time. Start planning at an early stage. so be absolutely sure that you have time to do it. • Set your priorities. Here are some tips for managing your writing time more effectively. or sleeping between 6 and 7 in the morning. by when and why. The normal type of deadline (‘I will/must finish this thesis within eight months’) is horrifying. We all live 24 hours a day. putting on the posh overcoat). Break the task into smaller tasks – periods for background. you must also decide how to find the time. for the second draft. When you decide to go ahead with a major writing project. Wandering around promising yourself that you’ll do it as soon as you have time is a guarantee that you never will. for instance. • Choose your language carefully. Put these deadlines in your diary – and work to them. commit yourself – set yourself a writing goal and write it down. for thinking and planning. As set out so often in this book. it is several. for the first draft. • Block off time. and so on. Thinking A grossly underestimated and underused part of the writing process (see analytical skills. Writing is a time-consuming business. If you decide to go ahead. and scatter them with abandon (see style. Look for the current buzz words. Time management Writing is not one task. Those who write most successfully (have 234 publications to their name or seven books all on the same subject) are not necessarily the better writers – but they are almost certainly the better managers of time. One of the purposes of writing a thesis is to show practising members of the profession or discipline into which you seek entry that you know the jargon (or technical language) that they use. Throat clearing See coughing. This is not the time to use plain English. Time management skills are crucial. the first step is to work out what you want to do.

• Plan ahead. And then set a new one. Look in journals and you will see all kinds of different styles: the BMJ for instance seems to like colons. Work out when you want the writing to be finished. Do not write your title until you have written your paper. and therefore become touchy about how we address them. Record your progress in your diary. Others like verbs (declarative titles): ‘Left-handed writers are more likely to construct long and boring sentences. thereby breaking the large task into smaller ones.’ The implication for authors is clear. Then work out the tasks that need to be done on the way. Remove distractions. Then treat it as a separate writing task: look at the ‘market requirements’. Mr. then meet them (see evidencebased writing. It will also stop you getting bored (and passing your boredom on to your writing). ‘Left handedness and writing styles: a randomized double blind trial’. The answer is simple: it’s what the editor of the journal thinks is a good title. It is difficult to block off two or three hours. • Create the right environment. See breaks. Lord) there are two guiding principles: follow the style of your journal and offend those you write about as little as possible. as in. arrange to meet regularly as a writers’ support group. Timetables See deadlines. This means writing on a clear desk. • Build in incentives and rewards. Professor. headlines). When it comes to titles (Dr.THE A Z OF MEDICAL WRITING – • Do little and often. Reward yourself when you have met your target. Titles (to articles) What is a good title? This is the kind of question that those writing scientific papers get terribly steamed up about. The first principle should always take preference (see style [2]). but why not 15 minutes a day? You will be surprised how much you can achieve. Titles (for people) People feel very strongly about the position they have worked themselves up to. If there are other people involved in a similar writing project. 130 . These blocks of time need not be very long.

TOPIC SENTENCES

Topic sentences What Americans call the first sentence in each paragraph. These sentences define what the paragraph is all about (see yellow marker test). Training courses There are many courses nowadays on the skills related to writing and (as a course provider) not surprisingly I am in favour. But they are not cheap, and if you want to go on one you should first do the following. • Work out exactly what you want the course to help you achieve. What are the problems you want to solve or the benefits you are seeking? Do you have an article you want to publish? Are you having a bad time from your boss because you do not write well enough (whatever that might mean)? Don’t just sign up because the advertisement looks good: do so only if it meets the development needs you have identified. Read carefully the objectives of the course to see if they will help you to meet those needs. Review the needs annually. • If in doubt, speak to the trainer before you sign up. The key to running successful training courses is to have the right people on the right courses, so it is in everybody’s interests to get this right. Again be clear what you want to achieve: state your goal and how it could be met. Assess the answer carefully. • Choose the type of training that you will feel comfortable with. Courses vary from those that bring in eminent talking heads to talk to groups of 100 or more to smaller workshops with fewer than 10 people and one tutor. Find out what techniques they will be using, and choose the type you feel most comfortable with. • Make sure that you cannot achieve your development goals in any other way. Courses are not the only way to learn. There are many alternatives, such as books, job swaps, finding coaches and mentors, keeping your own development logs. These will usually be cheaper. Travel writing Going on holiday, like being ill, is one of the more interesting things that happen in our lives. As a result, editors are inundated with articles on these topics. Unfortunately, their interest to the writer far outstrips that to the reader. The market is overcrowded and those travel writers that do get published are either staff reporters on a sponsored trip, or talented professionals who make it all look deceptively easy. If you insist on writing about your travels, consider the following:
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• Decide if you are writing it for publication. Most travel articles are commissioned in advance. Occasionally some publication or travel board might run a competition, but usually the chances of getting published are small. So why not forget about publication and instead write for yourself and your family – for the satisfaction of organizing your thoughts and of creating a memoir for the future? • Decide if you are going to write about your trip before you go. If you want your writing to be more than run-of-the-mill, you will need to observe carefully, ask questions, seek out the unusual and take careful notes. This needs to be done at the time, not on the plane on the way home. • Grab the reader. Do not start at the beginning (‘As the plane banked in over the sweltering desert, my thoughts immediately turned to the two challenging weeks that faced me.’) Instead, pick out a defining moment – an incident or a place or a person that you can describe, thereby attracting the reader, as in: ‘What’s a didger-eeedoo?” giggled the wide-eyed fresh-faced girl from Denver, Colorado ...’ • Write for the reader, not for yourself. Travel writing isn’t about you, it is about where you have been and what is worth telling about these places. The trick is converting what has interested you into something that is of interest to someone else. Describe the differences. • Use nouns and verbs. Instead of talking about the ‘wonderful hotel’, ‘superb food’ and ‘breathtaking view’, be specific. Talk about smoke-dirty oak beams and sky-blue clay tiles, trout plucked from mountain pools and fried with almonds and butter, the smell of lavender on garlic, the constant scritching of the crickets, and the waiter with soup on his tie who spent more time combing his hair than passing the gravy. • Read good travel writers. Buy some of the books from the greats, such as Jan Morris, Bruce Chatwin and Paul Theroux. But also look at some of the shorter features in the weekend supplements: these may be competent rather than brilliant, but they have been published.

Troublesome words
spelling.

See confusing pairs; homophones;

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TRUTH

Truth It is unwise to expect your writing to describe universal truths. Writing is a perishable commodity, and writers should be satisfied when they have a plausible idea, supported by reasonable evidence, presented in good faith (see scientific papers).
A lot of people have strong views about which typeface to use, but the current consensus is that, provided you use a familiar type, the type of type will be less important than the size of type you use (see monologophobia). For most middle-aged people, 12 point is comfortable. See also layout. Be consistent. Never reduce your typeface in order to fit in all the words; cut the words out instead. Never show off (see polyfontophilia).

Typefaces

UK-US English

This can be a major problem, though it is an area where people may find it easier to adapt if one of the Englishes is not their first language. I have so far been unable to find a simple book that will guide readers through all the pitfalls, but here are some useful pointers. • Same words, different spellings. There are several groups of differences, mainly concerning the US English preference for fewer vowels. Thus ‘honour’ and ‘labour’ become honor’ and ‘labor’, and gynaecology’ and ‘haematology’ become in US English ‘gynecology’ and ‘hematology’. The endings –ise and –ize seem fairly interchangeable (though the US, the Oxford English Dictionary and the housestyle of the publishers of this book favour the -ize). The word ‘program’ now has universal acceptance, particularly when it applies to computers. This still leaves the odd pitfall, like ‘grey’ (UK) and ‘gray’ (US). Nowadays of course the problem is much less than it used to be, because your computer program (stet), if handled with sufficient knowledge and tact, will automatically point out when your spelling wanders over to the wrong side of the Atlantic. That is good news, except for paragraphs like the two previous ones which, 133

on the UK side it is a vulgar word for drunk. ‘zip’ and ‘zipper’. the UK English speakers to be ‘for a moment. two different styles: It is generally felt on the UK side that Americans prefer a more expansive style. in US English to keep up trousers. A classic confusion is when pilots say we will be flying ‘momentarily’: the US English speakers understand this to be ‘in a moment’. different meanings. oranges. It also comes from a feeling that Americans are more verbose and less Anglo-Saxon. oranges and pears’ whereas US usage has ‘apples. Who knows? This should not give major problems to those writing for international journals. A dresser in the UK is where you put your china. • Same words. Misunderstandings can arise with nuances of punctuation. different words. 134 . The spread of US programs on computers means that some of these practices are spreading. however: UK English has ‘anaesthetics’. In UK English ‘suspenders’ are used to keep up stockings. Thanks to films and TV. ‘pavement’ and ‘sidewalk’. ‘nappy’ and ‘diaper’. ‘elevator’ rather than ‘lift’). a well-trained technical editor should be able to make the necessary changes quite easily. There are several major differences. we tend now to have little trouble with them. If you have worked out in advance where you are to publish your article (see brief setting). such as ‘queue’ and ‘line’. only’. Do not get obsessed by it: this is not a test of international crossdressing. as in ‘Colons: a difference in punctuation’ (US – ‘Colons: A difference in punctuation’). often because people don’t always realize that there are these international differences. ‘autumn’ and ‘fall’. whether we like it or not. • Same meaning. throughout the UK and the rest of the world. end up automatically ‘corrected’. • Differences in punctuation. ‘chemist’ and ‘druggist’. in US English ‘pissed’ is angry. then this becomes one of a number of specifications that you can meet without too much trouble. in the US it is where you put your underwear. ‘Mad’ is insane in UK English but angry in US English. • Two countries. with the word ‘program’ persistently being changed back to ‘programme’. UK English will use the lower case after the colon. and pears’. US English has ‘anesthesiology’.THE A Z OF MEDICAL WRITING – if you are not careful. UK English uses commas in lists thus: ‘apples. there is ‘got’ (UK) and ‘gotten’ (US). To some extent this comes from some of the words (‘apartment’ rather than ‘flat’. ‘cot’ and ‘crib’. ‘tap’ and ‘faucet’. US usage also favours capitalizing the words in titles (as in ‘Patient Released Prematurely from Hospital’). There are some more subtle changes. If you don’t get it absolutely right. ‘aluminium’ and ‘aluminum’.

UK US ENGLISH - On top of this. Beware the occasional pitfall – my American wife worried for weeks because I had proposed building a dresser in the kitchen. and have another go. We should commit to print the latest information we have to hand. But we can do only so much. Some people use this as an excuse for not parting with the final version. Unpublished articles Too many people leave lying around in bottom drawers articles that could be published if only they could just summon up that extra burst of energy. and run through your copy with them. It is often better to go for the ‘latest reasonable’ rather than wait for the ‘final and definitive’. find a friendly and literate American (which shouldn’t be too difficult). Unpublishable articles Unfortunately some people feel that working long enough on a piece of text will increase its chances of being published (see Icarus fallacy). match it to another market. Take out the article. people may be fooled into thinking that you are clever. Upper case Up-to-date See pompous initial capitals. This is not true. Uncommon words You may feel that sprinkling your writing with these sends a signal that you are learned and cultivated. 135 . if you use more they will consider you pompous and may well stop reading (see post spelling bee traumatic disorder). But many authors suffer from demotivation. go back to the first stage of writing (brief setting). and we can usually identify articles that stand little chance of being published before we start writing them (see brief setting). This rarely works. If you use uncommon words sparingly (one per item of writing).

The group has also issued a number of statements on layout of references. some of which will refer you back to the Vancouver guidelines anyway. the first group of editors met informally in Vancouver in 1978 and now. American College of Physicians. International Committee of Medical Journal Editors. can usually be obtained via a participating journal. PA19106-1572. They are useful statements. authors should start with their target journal’s Instructions to Authors. which include the statements. now in its fifth edition. fed up with having to retype manuscripts that were doing the rounds from journal to journal. they meet every year. FURTHER INFORMATION Uniform Requirements for manuscripts submitted to biomedical journals. It is not yet used to describe the growing practice of paying to have one’s scientific paper published. and confidentiality. under the formal name of the International Committee of Medical Journal Editors. Take ‘geriatricians’. definition of a peerreviewed journal.THE A Z OF MEDICAL WRITING – Vancouver group Legend has it that the impetus for this group came from a group of editorial secretaries. Annals of Internal Medicine. Independence Mall W. These set up common guidelines for submitting to journals – all of the 500 participating journals will consider all manuscripts that conform to this common style. and on contentious matters. Whatever the cause. One of their major activities is producing the Uniform requirements for manuscripts submitted to biomedical journals. from the setting out of references to the function of each section of a scientific paper. But when preparing manuscripts. Sixth St at Race. ‘monkey wrenches’. and copies of the guidelines. Philadelphia. ‘back pain’ and ‘hospital 136 . editorial freedom and integrity. Verbs These are the ‘doing’ words (the Dutch call them ‘work words’) that turn a phrase or succession of words into a sentence. Their main value is that they show clearly how editors think on all kinds of matters. Vanity publishing A phrase used to dismiss those who pay to have their poems and novels published. conflict of interest. available from ICMJE Secretarial Office. such as redundant or duplicate publication.

a verb and an object.’ But sentences such as: ‘We have all been obsessing about what we could have done differently’ can seem excessive. Vocabulary Most of us have quite enough to put our messages across (see word choice). Voice This is one of the most controversial areas of writing. ‘to determine’) into less vigorous and more pompous nouns (‘the inspection of ’.’ This gives an appearance of objectivity. The active generally consists of a subject.VERBS beds’. cause trouble. ‘the determination of ’).) 137 . They can. and can be harder to understand.’ Verbs give direction to a sentence and are vital for formulating workable messages at the start of the writing process. particularly when the sentences start to get longer. but add some verbs and the story begins. Very Should be used occasionally. Thus ‘I saw the patient’ becomes ‘The patient was seen. We can usually find a more familiar way of saying such things. For instance: ‘Geriatricians should hit the hospital beds with monkey wrenches to avoid back pain. particularly when it comes to writing scientific papers (see tenses). Also be careful about turning nouns into verbs: we can probably get away with: ‘We stretchered them to the city where they were hospitalized. but it has left out an important piece of information: who did it? (For the cynical this explains why the passive is so popular: it implies objectivity while at the same time protecting anyone who was actually involved. Yet many people believe that the ‘proper’ way for a scientist to write is in the passive. as in: ‘The doctor studied the chart. Avoid turning vigorous verbs (‘to inspect’. which doesn’t mean that you can overuse other words like ‘exceedingly’ instead. particularly when it comes to writing for a scientific audience. on occasions.’ The disadvantages of the passive are that it is longer and less vigorous.’ The passive is when the object of the action becomes the subject of the sentence. In themselves they mean little.’ or ‘The geriatricians were hit with a monkey wrench and are now lying in hospital beds suffering from back pain. as in ‘The chart was studied (by the doctor). Verbs can be in one of two voices: the active or the passive.

as in: ‘A 15% pay increase for all doctors was recommended by the Review Body yesterday. Use the passive: • if most of the articles in your target publication still use it: look at your target journal and see what they favour (see evidence-based writing). but you should never use that voice for the covering letter. Yet it persists in the pages of journals....THE A Z OF MEDICAL WRITING – Nowadays most writers on writing urge authors to use the passive sparingly. Jones and Brown agreed that . Younger researchers often report that their professors have changed their vigorous sentences back into the passive. • if you want to avoid responsibility: ‘It was decided to send the patient home’ may have distinct advantages over ‘I decided to send the patient home’ if there later turns out to be a court battle (but it is cowardly). It all becomes very confusing. • in the first sentence of a piece of writing: sometimes it is necessary to turn a first sentence around in order to put the more interesting part at the start.. but these publications almost always prefer the active (see evidencebased writing). in which we established conclusively that . so here are some guidelines. write these in the active: ‘We need another portable x-ray machine immediately’. is that they give protection when things go wrong.. • if you are writing minutes: the convention is to write. • when you are writing a covering letter to an editor: the article itself may be in the passive (see above). because ‘that is the way science is written’. specialist journals will tend to use the passive. possibly because they have smaller staffs and therefore less time to make changes of style. • when you are writing for a newspaper and a magazine: check first. • in abstracts: there is a convention that abstracts are written in the passive. be active: ‘We enclose our study. the whole point of most minutes.’.’ Otherwise use the active voice. • when you are asking for a decision: there is a growing trend for executive summaries to give decision-makers the information they need. follow this style.’. which is particularly useful in the following situations: • when you need to get a clear message across quickly: ‘I will intubate’ rather than ‘Intubation will be started’. after all. ‘It was agreed that . 138 . as opposed to action lists.’ rather than ‘Smith..

co. pompous words. which poses huge questions for. gobbledegook and jargon. 139 . But the principles of working out what the market requires will still hold true (see effective writing). World Wide Web We can now use our personal computers to send messages around the world immediately and at little cost. but have been sent out to readers instead. it will not go away. Select the words that will enable you to put your message across most effectively to your target audience. They may need to adapt their writing techniques to take account of the fact that we do not use the computer terminal in the way that we use a book. This represents a major revolution in the way we use the written word. the real wasted paper is not those crumpled up sheets that get thrown into the waste paper basket. cut the words rather than take away too much white space.timalbert. Whatever happens. You may find a useful starting point in www. whether we like it or not. the major change is that vast expanses of material for research have been opened up. Log on and start using the World Wide Web. Avoid tautology. Use plenty of white space to frame the words. Or try me on: www. As for the impact on authors.WASTED PAPER Wasted paper Contrary to what most people think. those running academic journals (see electronic publishing). which they can roam without leaving home.com. Potentially we are all our own publishers. Keep everything simple: don’t use a long word if a short one will do. the way our work looks on the printed page plays a major part in the way in which the reader will approach it. Word choice Avoid any temptation to show off (see false feedback loop) and don’t be obsessed by monologophobia (see post spelling bee traumatic disorder). They are those bits of paper that should be in the waste paper basket.useit. White space Writing is a visual medium and. If you have more words than you have room for.uk. Hours of agonizing over the exact words to use can be swiftly undone by thoughtless layout. One of the important considerations is where the words do not appear. among others. Use nouns and verbs rather than adjectives and adverbs. flabby phrases.

such as sitting paralysed in front of a blank screen. or more subtle displacement activities such as cleaning out the attic or searching for the one piece of research that will put everything in perspective. Do not confuse writing with authorship. and I have identified the following types. while your subconscious brain gets to work on the problem. It may take a variety of forms. Writer Someone who is involved in the creative process of making sense of a mass of ideas and putting them onto a piece of paper in a way that has a good chance of being read. you should be able to plan the piece and start writing. Don’t panic. A technique such as branching will help you get the mess of information out of your head and onto a piece of paper. Though the symptoms are often similar. Then turn to the sections on getting started and the process of writing. how to See process of writing. do something else for a while. Once you have done this. the underlying causes are various. which is a claim to part ownership of a scientific article. Write. It calls for individual suffering. and even why. What they are exhibiting is the pain that comes with doing a difficult job well. there are many people going around feeling that they have major problems when it comes to putting out their thoughts. Writer’s block A commonly used phrase that refers to the suffering we endure when we should be writing – and aren’t. • Type II early onset writer’s block. But now the problem is fear: there is so much information that we are reluctant to make decisions about how to use it in case we make a mistake and are damned forever. This is rarely so. as in health care. This generally starts when we are required to do a piece of writing but have no firm idea where to start. • Type I early onset writer’s block. The paralysis may stem from the fatal combination of a woolly brief and the need to start writing straight away.THE A Z OF MEDICAL WRITING – Worried well In writing. More often. We may have a clear idea of what we are writing. it comes simply because we haven’t done enough thinking. and attempts to do it in small groups rarely work. and usually involves arguing about what someone else has written rather than doing any writing yourself. We may also have done hours of high-quality gathering of information. 140 . for whom.

• Boredom. which is much easier. and suddenly we grind to a halt and cannot continue. in which case the best thing is to stop. if it works for slimming. and they should meet regularly. and go back to the beginning to set another brief. Members of the group should be roughly at the same stage in terms of writing experience. The glib one is to start with the second sentence. or theses. groups of writers should join together to give support and encouragement.. One solution is to take a rest: go and do something completely different and preferably physical. An even better solution is to make sure that we know how we want to begin before we reach this point (see first sentence). We should then be able to get going immediately. for 10 minutes.. We have blocked off two hours or so of protected time and have moved to the word processor. almost anything) intensively for an hour or so we become bored. This is when we are in the middle of even a short period of writing. so we sit there . There are two solutions. such as scientific papers. take a rest. This is particularly true of major projects. and sit there. If we do anything (well. So. like weeding a flower bed or scrubbing a floor. nor the speed with which the intention to write can dissipate. We cannot start until we have found the perfect first sentence. major reports. otherwise it will become an opportunity for 141 . it will take only a matter of minutes to knock off a new first draft. Here the prizes go to the persistent rather than to the clever or the knowledgeable. Do not regard writing block as a sign of failure. Writers’ support groups Never underestimate the difficulty of sustained writing. surrounded with every conceivable piece of relevant information. This is probably nature’s way of telling us that we haven’t prepared thoroughly. Don’t panic: once we know where we are going. it is a sign that we are taking trouble to produce something worth while (see process of writing). Another is to make sure that we allocate only brief periods of time – up to 15–20 minutes – for our writing (see free writing). After all. • Mid-stream writer’s block. This needs organization and discipline – and also support.WRITER S BLOCK ’ • Perfect first sentence syndrome. it should do so for writing. We tend to block off too much time for our writing. Then we freeze. perhaps every two or three months. whenever possible. this can be effective. There should be about half a dozen members in the group.

brief setting)? • Set deadlines and monitor progress. Agree on the deadlines that you will have to meet if the targets are to be achieved. There is quite enough textual flagellation about. defensive writing. It will institutionalize the false feedback loop and ensure that the group misses its targets. books. Use the meetings to record individual progress. books. How many papers will the group plan to produce within a year? How many papers will each member plan to produce? Which journals will they target and who will the co-authors be (see writing goals. or more delicate ones such as persuading the professor to return the paper you sent him three months ago. science writing. Writing Writing for different audience Not a specialist technique but the skill that goes right to the heart of effective writing. and ensuring that deadlines do not slip. and at least once a year. takes up a tremendous amount of time. research into writing. writing of. the group should celebrate its success. • Pool information and solve problems. Sharing problems and solutions will encourage the group to keep moving towards its targets. Every so often. This whole book is about writing but there are main sections such as advice on writing. • Define group and individual targets. Difficulties will surely emerge. free writing. It is worth taking care over the kind of things you will allow members to talk about. Writing goals Writing. When you start 142 . Some may wish to set a league table of celebrations. whether they be technical ones such as using a particular piece of software. bad writing. If you allow the group to start getting involved in this you will usually end up with the work of those who have met their targets being criticized by those who have not. It is surprising how much expertise can be found in a group of six people. • Celebrate success. so that the greater the success the better the party! A final caution: these meetings should be used as an opportunity to discuss whether the work in hand is being produced. efficient writing. Invest this time wisely. and not to discuss the work itself. writing of chapters in.THE A Z OF MEDICAL WRITING – political manoeuvring and showing off. when done well. concise writing. This is a good way of maintaining motivation.

143 . When do you want to have achieved this? • Evaluated. you can transform your dread of writing into well thought-out. the better. you need one or two original papers in major journals. Now decide on – and also write down – your objectives: what you need to do to meet these goals. and indeed whether the goals remain the same? • Revised. to tell people about the interesting things you are doing. goal-related behaviour. to make money? The answer(s) should give you some idea of what you need to do: if you want to advance your career. This means spending time working out – and writing down – your writing goals. How will you define what you want to achieve? The clearer and more detailed it is. to see your name in print. Why do you need to write: to advance your career. • Measurable. Is it possible to achieve what you have set out to do? • Time specific. For the price of committing yourself to paper. • ‘Complete the article already in draft and send to the European Journal of Left-Handed Surgery within three months’. • Specific. Your writing should thus be converted from a millstone into a tool. When and how will you review what you have done and see whether you are meeting the goals. Do you need to change your goals and objectives? Objectives that are difficult to achieve are: ‘Write two articles for journals’ and ‘Read some more about writing.WRITING GOALS on a major writing project.’ Applying the above principles produces manageable alternatives. do so because you want it to achieve something and not because you rather feel you should. A much-loved mnemonic in this regard is SMART. rational. if you want to tell people what you are doing then perhaps a feature article in Pulse or Hospital Doctor – or a newsletter for patients. How will you know you get there? What will be the criterion by which you will consider yourself to have succeeded? • Realistic. we go one step further with SMARTER. • ‘Do a computer search to identify a book that talks about writing style and read it before the end of this month’.

144 . much less have any success in a second language. your writing will probably be well structured and easy to follow. It will be divided into (1) ‘bones’. • Highlighting the end of paragraphs. They start with a gentle introduction and build up eventually to an interesting bit at the end. then their thinking can’t be very good either. This makes sense: paragraphs are the building blocks of writing. If. albeit in abbreviated form. Identify full sentences only. much less a third or fourth. This is a particularly British attitude. The question to ask is whether the paragraph. Yellow marker test Over the years I have found this simple test an extremely useful tool for understanding the structure of a piece of writing. If you have consistently highlighted the first sentences of each paragraph. so that you will be able to read them in order and keep the sense of what you have written. your writing is not easy to follow. And (because I can’t think of any other suitable words beginning with ‘x’) this concept can be extended to the feeling that.THE A Z OF MEDICAL WRITING – Xenophobia A deep dislike of foreigners. on the other hand. and (2) ‘flesh’. We should bear in mind that most of us can’t write good English anyway. Take the highlighter and identify those sentences that you think are more important than the others. the yellow marker test will give some useful information on what could be going wrong. You have now identified the writing’s structure. so putting the important sentences up front will define each paragraph and ensure that the argument develops in an accessible way. those sentences that elaborate or support your argument and will have been left unmarked. those sentences that take the action or argument forward and which will be highlighted in yellow. • Highlighting the first sentences of each paragraph. This reveals the tendency of well-trained scientists to apply the structure of scientific articles (see IMRAD) to individual paragraphs. would work better if it were turned around? Generally it would. All you need is a yellow highlighter and several paragraphs of text. and the piece as a whole. if foreigners don’t write in the way we are used to.

Monday is really Tuesday. yet the yellow marker test has shown that they are not. What are these paragraphs doing? You may be giving the reader plenty of information. or (2) write a new key sentence for the start of each paragraph so that the reader can understand why the information is there.’ • A series of bullet points where some are highlighted and others not. • Paragraphs where nearly every sentence is underlined. It is a better use of time than fiddling with someone else’s style (see macro-editing). for instance. Writing a key sentence could do the trick: if you have six important reasons why. Here it would appear that a key point has been buried.YELLOW MARKER TEST • Highlighting sentences in the middle of paragraphs. There are two main remedies: (1) agree that the unmarked paragraphs are redundant. The remedy is simple: rank in strict order of importance or consider two or more lists. you can hope to have a little more of it. 145 . then bind them together with a new key sentence: ‘There are six reasons why Monday is really Tuesday. Enjoy: tomorrow could be another writing day. A bullet point list implies that all points are of equal importance. it will usually tell you why. This reveals a contradiction. so cut them out. Once you have written what you have set out to write. Zzzzz Sleep: a precious commodity. Would the paragraph work better if it were promoted to the top? • One or more paragraphs with no highlighted sentences. The yellow marker test is particularly valuable when preparing balanced feedback for a colleague: if you feel that a piece of writing is not working. then you are in danger of writing a shopping list. but without a framework on which that information can be digested. This is another sign of overload: if all sentences are of the same weight.

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